Nutmeg: Rabbit head tilt

Meet our Easter bunny, Nutmeg!

Little Nutmeg came to us for a second opinion after going off of his food, developing a head tilt and paralysis to one side of his face. A swab from his ear revealed a growth of bacteria, and a CT scan revealed that his right bulla (within the ear) was full of pus and part of the wall had been destroyed. The CT also revealed a dental abscess affecting the left side of his face within the mandible (bottom jaw).

He had a dental procedure and surgery for his abscess, and has had pain relief and antibiotics for his ear.

Sometimes in these cases, surgery of the ear canal needs to be performed (lateral wall resection or partial ear canal ablation) too. Despite still having a head tilt, Nutmeg has taken on a new lease of life and is doing very well at home.

Head tilt in rabbits can be caused by a variety of issues. The most common reasons are e. cuniculi infection (a microsporidian parasite of the brain and kidneys) and otitis media/interna (infection of the middle/inner ear, especially in lop rabbits).

E. cuniculi causes these clinical signs through forming areas of inflammation, so anti-inflammatories are needed as well as the treatment for the parasite. For inner ear issues, x-rays are only ~50% sensitive, and so ideally a CT scan is needed to identify inner or middle ear issues. Other reasons for head tilt include toxins, tumours, toxoplasma parasites, trauma, infections, and illness within the body resulting in secondary neurological signs.

In all cases, they often need supportive care to help them whilst a diagnosis is being made. Rabbits that develop head tilts often don’t have them fully resolve, even after treatment, but they usually adapt well and still have a good quality of life despite this.