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ear abscess/infection

22 11:19:18

Question
Dear Dana,

Our bun (4 yr old neutered male) developed a lump by his ear. on surgery it was found the infection stemmed from inside the ear canal Staph Aur spp sensitive to baytril,  he had had 3 surgeries to open and clean out the area, with a hole into the canal which we flush 3x daily with saline, hes had baytril for 4 weeks it then developed resistenace, then cul & sens testing showed cephalexin would be ok 4x weeks and now resistance has developed but it is now sensitive to baytril again., and now is back on baytril. i am being offered gentamycin beads to be put into the ear with tris-edta mixed with antibiotic to be used to flush the area as my last option, are  i thought gentamycin was ototoxic? i have read it is


http://www.mth.kcl.ac.uk/~llandau/Homepage/Rabbit/headtilt.html

what are the risks?
what are the options

and what is the prognosis?
my dear little soldier is being so brave, AND is still bright happy and loving despite 2 months of treatment.

thanks

Cherry (and little trigger)

Answer
Dear Cherry,

If this were my bunny, I would use gentocin only as an ear flush, but not systemically, as it can be quite rough on the kidneys.  The ear in its present state is probably not very good for hearing, so given the options of a permanently chronic ear infection and the possible loss of some hearing, I'd opt for the latter.

However, if you have a very experienced rabbit vet in your area, you might want to discuss the option of a lateral ear canal ablation.  This essentially opens the lateral portion of the ear canal (from the outside to the point where it makes a 90 degree turn into the head) so that pus can not only drain out better, but the ear can be flushed more effectively.  

In a very severe case, the internal canal can be ablated, but that's pretty extreme.  The vet who is pioneering this procedure in rabbits is Dr. Vittorio Capello (he's in Italy, unfortunately), and he has given numerous talks at vet meetings throughout the U.S. on this surgery.  Please ask your vet to contact some other vets via one of the many exotics vets listserves to ask about the procedure for bunny, and see if he's a reasonable candidate.

One vet in our area is doing this quite frequently now.  This is Dr. Susan Kelleher, and your vet can call to consult her at (954) 968-7171.  (She will take calls only from vets, not from other vets' clients, for professional courtesy reasons.)

The prognosis?  Hard to say, but many bunnies live quite happily even with such a nasty, chronic infection.  Ear flushings really seem to help, and using a pediatric ear bulb to gently suction out the pus (flush with warmed Chorhexiderm) seems to help a lot.  As long as bun is eating, drinking, pooping, and enjoying life, we do the best we can to keep her comfortable, and leave it at that.  I certainly wouldn't make any "drastic choices" on her behalf just because of an ear infection.

I hope some of this helps.

Dana