Head tilt went away on its own, then came back.

[Stacie]

Hi. I have a 7 year old Netherland Dwarf bunny who has had head tilt for about 3 years. Antibiotics haven't worked and until now, we have resigned ourselves to the fact that we have a special needs bunny.
About a month ago, Abraham's head stopped tilting. Just like that, out of the blue, all of the sudden. We made no changes to his diet and his eyes returned to their regular size. Everyone was elated. Then, as quickly as it went away, it came back. It's not as severe as it was, but it seems to be progressing.
I can't seem to find anything online about this and was wondering if anyone here has had any experience with this. Thank you.

 

[JBun]

Have you taken him to the vet? Have any tests been done to determine if it is an ear infection or e. cuniculi that is causing the head tilt(e. cuniculi blood titer, examination of the ear, xrays to look for an inner ear infection), now and/or when it first happened? How was it determined that antibiotics were needed to treat it the first time? By 'his eyes returning to their regular size', do you mean that they are normally bulging, and how long has that been going on? Has the vet investigated that at all? What antibiotic was he on, how long ago, and for how long was he on it? Has he been on any other meds besides the antibiotics?

 

[Stacie]

Initially, we took him to the vet. She gave him antibiotics (not sure what kind) and it went away. Within a few weeks, it came back. We tried the same antibiotic again with no results. She switched his antibiotic to Sulfameth/Trimeth and again, had no results. In order to further examine him (xrays, mri etc.) I would have had to take him 2 hours away and she estimated that the costs could have been upward of $1000.
His top-facing eye was bulging and the bottom facing eye was squinting. The vet said that was due to an over-compensation/protection mechanism. This has been going on for most of the illness.
The vet said that it could be a neurological issue but since he responded immediately to the antibiotics the first time, it was likely an infection. It doesn't seem to be causing him any pain. His disposition is the same and he eats and drinks regularly. The only thing that has changed is the fact the he is no longer litter trained. I chalked that up to him not being able to positon himself properly.
He was on antibiotics for about 6 months and hasn't been on any other meds.
While searching the web, I found that head tilt can also be caused by toxicity. He likes to chew his plastic litter box. I'm not sure exactly when this started but I'm wondering if this may be a contributing factor. I might be grasping at straws here but I'm completely dumbfounded...

 

[JBun]

The thing with head tilt is that permanent damage can be done, either by the infection in the ear, or if it is caused by e. cuniculi, by the inflammation in the brain. So even though a rabbit may get better and recover from the disease/parasite, the head tilt may never go away completely and will remain a permanent disability. So it sounds like the infection did clear up again with the second course of antibiotics, but that some damage was done and the head tilt remained. If the antibiotic hadn't worked, your rabbit's condition would have continued to deteriorate.

I don't know why all of a sudden you would see improvement in the head being tilted, then for it to go back to how it was. It's possible that an infection has returned. Have you noticed any worsening of symptoms or has he just returned to how he was before? I don't think that chewing on the plastic would have any affect. Usually rabbits just chew those things but don't ingest any of it, but even if they do, the pieces should just pass right through their digestion. Unless your plastic has lead in it, but then I think you would be seeing other symptoms as well, if it did.

I am wondering about the urinary incontinence though. It's possible it is due to his permanent head tilt, but one sign of e. cuniculi is urinary problems and loss of litter habits. It would be a good idea to get your bun checked by your vet if you haven't been in already. You may want to ask about treating for e. cuniculi with a 28 day course of panacur(fenbendazole), because of the current urine problems, if the urine problems aren't due to a UTI or other common urine issue. I don't know if it will help, but it usually doesn't hurt. If there has been a worsening of the head tilt, then antibiotics may be needed too.

http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm
http://www.bio.miami.edu/hare/tilt.html
http://www.rabbitwelfare.co.uk/resources/content/info-sheets/ecuniculi.htm

I thought this link on disabled rabbits might be helpful too, in case you are having difficulty with the loss of litter habits.
http://www.disabledrabbits.com/urine-scald.html

 

[Stacie]

There haven't been any worsening of the symptoms. He's actually not as bad as he was before, but, the symptoms have been progressing.
I wasn't exactly clear earlier. By saying that he is no linger litter trained, I meant that he defacates in his cage and on the floor. He still only urinates in his box. Originally he was completely litter trained. He would hop around the house for hours and only defacate/urinate in his litter box.
Something must have happened to cause this sudden improvement. We always give him the scrap/extra vegetables that we are using for cooking. For the life of me, I can't recall exactly what I gave him when the head tilt ceased. I wonder if something was decomposing and it had a penicillin-like effect. (Grasping at those straws again!) I will bring him back to the vet, hopefully I can find a different one in my area that treats bunnies.

 

[JBun]

The change in litter habits could just be that it is getting harder for him to use it.

You can try these rabbit vet lists. Hopefully there will be something near you and the vet will have some answers for you.

http://www.rabbitsonline.net/f28/finding-vet-13366/
http://rabbit.org/vet-listings/