Can an ear infection be missed with only a visual exam?

[cmh9023]

My vet gave my girl with head tilt a thorough look with one of those scopes that go into the ear and saw no infection. I was just looking over my receiptfor all the services she got that day. It looks like the only lab work that is being done with her blood is for EC. Not an ear infection. So I was wondering if it is possible or common for a vet to miss an ear infection by only doing a visual look?

She is currently taking Oxybendrole for the possible EC but she didn't prescibe anything for infection. I've been reading old posts and it seems like it is more common to treat for both at the same time. Is that correct?

She is also taking taking an injectable steroid call dex-sodium phosphate. I can't recall what that is for, but I don't think it is for a possible ear infection.

Thanks.

 

[Maureen Las]

According to kathy Smith "Rabbit health in the 21st century"
an ear infection usually will have a discharge. the discharge would then be cultured.

if not discharge is found A skull x-ray could possibly be done to confirm the presence of an inner ear infection and if that doesn';t show anything an endoscopy could be done.

I think that your vet may be attempting to diagnose the problem by doing one treatment at a time.

if it is EC she should respond to the fenbendazole and if she doesn't then maybe your vet would look further.


Randy usually will say that head tilt is usually cause by an ear infection but often some inexperienced vets will automatically assume EC and not do a thorough check of the ears. in your case your vet did doa check
I have a friend in Chicago whose rabbit developed a tilt several months ago. The vet did a thorough checking of the ears and no infection showed. The rabbit was put on fenbendazole and did improve. So the assumption is that the bun has EC

 

[Maureen Las]

Dexamethasone is given for swelling and inflammation. I'm not sure why this was prescribed.

A steroid would make an infection worse so I don't think that your vet feels that this is an infection.

Iwould usually be distrutful ofa vet and doubt all of this but to my knowledge you have a good rabbit saavyvet right?

 

[tonyshuman]

I would guess that the steroid is to help with possible neurological problems (EC). I would guess that the vet does think it is EC, not an infection.

 

[Flashy]

I think Randy says that you can't always see infection and that often a swab is needed to tell for sure.

With Tilly she didn't show any signs of head tilt, so the RSPCA did not treat her with an anti-biotic. When I got her two months later we did treat her with an anti-bitoic (Convenia) and her head improved dramatically.

 

[Maureen Las]

I would guess that maybe Randy did say that but I don't recall. I can understand that it would be a better diagnoses to have an ear infection than EC. if she doesn't improve quickly I would ask the vet to swab the ear for a culture even if nothing is visible to the eye.

here is a great article by Dana krempels. talking of the most common reasons for head tilt.


http://www.bio.miami.edu/hare/tilt.html


and how is she doing today ? any changes? :expressionless

 

[cmh9023]

I thought I had read that in one of Randy's posts, but I couldn't find it anywhere so figured I was mistaken. In the reading I've been doing it seems that to take a swab there would need to be some discharge or pus in the ear to get a sample of. I do have a good rabbit vet so she's probably doing what makes the most sense, but I had that stuck in the back of my mind about there needing to be a culture done.

I just got home from work and unfortunately she seems worse tonight. Yesterday she could wobble around a little and then tip over. Today she starts to roll when she tries to move around. I think I managed to get a full dose of Meclizine in her just now and she just had her fourth dose of Oxybendrole. She's eating on her own. Not a lot but some. She's also trying to groom her face. And she did stomp at me which is what she always does when she's feeling well. Maybe that's a good sign?

 

[Maureen Las]

Cara,

When are you supposed to check back with the vet.? IfJessie did havean infection the steroid would make it worse....
Iknow that you have a good vet so ,I would basically trust what she is doing but keep her up-dated particularly if Jessie gets worse....
Ihope that she does improve but at the same timeI wish that she had an ear infection rather than EC

'hugs"

Maureen

 

[tonyshuman]

Yeah, I don't know. To me it would make more sense to rule out an infection before ruling out EC, since the treatment for EC can take a long time and doesn't always show dramatic improvments, whereas with an injectible antibiotic you'd probably see improvement with a few doses. However, the vet may have other reasons to treat EC first.

 

[cmh9023]

She's going to the vet tomorrow for fluids but she's only seeing a tech. However, my vet will be there so hopefully she will stop by for a minute.

The injectible PenG was a lifesaver (literally!) for my girl Sherry. It was amazing. I feel like kind of a jerk askingthe doctorabout an ear infection again since she already told me she doesn't have one. But, I guess you've gotta do what you've gotta do if you want to set your mind at ease.

I'm going to print out the list of meds other head tilt buns have used and write down down of the newer ones people have mentioned. I wish I could find some of Randy's posts about this but I haven't had much luck.

 

[JadeIcing]

The key is pin pointing what is causing it. Some meds work wonders for one thing but squat for another. Sometimes the infection is so deep you won't see signs of infection.

 

[cmh9023]

Does Ringo have head tilt from an infection or EC? I'm about 1/3 of the way through reading his life story thread and I can't remember. I'm thinking infection.

 

[JadeIcing]

Infection.Reading his story you will see ups and downs.

 

[tonyshuman]

I think an infection that deep (into the brain) would require zithromax to reach it. Most antibiotics do not pass the blood-brain barrier.

 

[cmh9023]

Tonyshuman- Just want to be sure I understand (I'm taking notes for tomorrow)...

So something strong like Zithromax would be given if a culture came back showing she has an infection in her brain? I guess I also have to go back to the question of, can the vet do a culture/swab if there is no discharge in her ears (or nose, eyes, etc.)?

She's seems in pretty bad shape tonight. I sure wish the Meclizin would work a little bit just to ease her dizziness. She can't move without rollilng now. Sigh :cry1:

Cara

 

[JadeIcing]

Not sure what her set-up is like but this is Gabriel's.. The cushions help prop himself if needed. I also had smaller set-ups for Ringo at his worse. More or less the same just smaller.

Gabriel's set-up...

 

[tonyshuman]

I think the diagnosis for an infection that had progressed to the brain would have to be made based on history, actually. So the infection would have to start in the ear and progress from there to the brain. The inner ear is directly connected to the brain. I don't think an ear swab would be able to get at that. Another way to diagnose it would be to give the antibiotic and see if it improves.

I went back and found the thread that talked about brain stem infections and how they can lead to balance issues. I screwed up the drug name--it's Chloramphenicol that can attack infections in the brain, not Zithromax.
http://www.rabbitsonline.net/view_topic.php?id=45316&forum_id=16&

Poor girlie

 

[Little Bay Poo]

Just reading through this thread now. Two things I wanted to say on the chance they might be helpful:

1.) The vet swabbed Ronnie's ears for a culture and he didn't have any noticeable discharge. I remember them saying his ears looked pretty good and clear, so I don't know if the vet saw anything. I'm not 100% sure about the vet not seeing anything but I do remember her saying his ears looked good.

2.) Ronnie was started on Pen G immediately. No culture results or anything. He was given the Pen G on the first day as a precaution because the vet said she had seen cases like this and they usually respond to Pen G. She wanted him on it ASAP as it is better to treat sooner than later. We got the results of the culture many days later, and I'm glad that they gave us the drugs first instead of making us wait.

I have very little knowledge in this area and can only offer anecdotal advice, but knowing how bad off Ronnie was when he wasn't getting the Pen G, I hope you can find the right treatment for Jessie. I'll be thinking of you and rooting for her to get better!


ETA: I'm just remembering now, we also had the blood tests for EC done. I remember the test was called a "titer." The ear swab was what came back positive for Pasteurella, and confirmed that our treatment plan was appropriate.

 

[JadeIcing]

tonyshuman wrote:

I went back and found the thread that talked about brain stem infections and how they can lead to balance issues. I screwed up the drug name--it's Chloramphenicol that can attack infections in the brain, not Zithromax.
http://www.rabbitsonline.net/view_topic.php?id=45316&forum_id=16&

Poor girlie

That is what Gabriel is on.

 

[ra7751]

Only have a sec....overloaded with animals. Few things.....

EC does not directly cause tilt but may contribute due to a compromised immune system since the immune system sees the EC as the primary threat. The "bendazoles" that most vets are still using have proven to be mostly ineffective since they can't pass the blood/brain barrier easily. A much better treatment for EC is Marquis (Ponazuril). It is very expensive. In the real world, like all coccidia, the only true treatment for EC is a strong immune system.

Every case of tilt I have seen here without head trauma has always been traced to an infection in the middle and/or inner ear.

It doesn't have to be bacterial.....yeast is usually overlooked. Unlikely to be viral.

A bacterial infection can move to the brain and/or brain stem. This is particularly difficult to treat due to the blood/brain barrier. Few drugs can penetrate the barrier and it is a guess as to what the pathogen is. A couple of drugs that can pass the barrier is Metronidazole and Chloramphenicol.

STEROIDS ARE CONTRAINDICATED IN INFECTION SITUATIONS ESPECIALLY IF THE INFECTION IS SECONDARY TO EC. I don't know of many vets that use steroids at all any more....and when they do, it is a very unique situation. The idea behind steroids is to suppress immune system response. So it would be logical that if you have a bacterial infection presented that suppressing the immune system would not be theprudent thing to do. Steroids will bring down the main line of defense to both the bacterial infection as well as the EC. While I can't say I have never used steroids in rabbits.....it is something that must be meticulously considered....and looking at the big picture of immune response in rabbits....before I will use them. And certainly I would never use them with a vestibular issue....I won't even use ear drops with steroids (like Tresaderm) with ear infections.

I will try to get back later and give you more info.

Randy

The worst infection is always the "down" side.