Head Tilt
It is very distressing to find your bunny with a head tilt. Don't panic but do get them to a good rabbit vet as soon as you can for
treatment. The quicker you respond to the tilt, the best possible chance your bunny will have to recover.

Possible causes of head tilt (also known as torticollis
or wry neck) are:

* Middle/inner ear infection
* Stroke
* Trauma
* Cancer
* Cervical muscle contraction
* E. Cuniculi
* Intoxication

Inner Ear Infection
An inner ear infection may have started with
an outer ear infection, which remained unnoticed
and untreated and gradually worked its way into
the inner ear, or with a middle ear infection, which
resulted from an upper respiratory infection. Or it may
have arisen from bacteria in the nasal cavity or bloodstream. A radiograph of the head may help determine if the middle ears are
affected. Some of the bacteria which have been cultured from ear infections are Staphylococcus sp, Pseudomonas aeruginosa,
Pasteurella multocida, Bordetella bronchiseptica, Proteus mirabilis, Streptoccus epidermidis, Bacteroides spp. and Escherichia

Treatment needs to be aggressive and prolonged. If pus is found deep in the ear canal, a culture and sensitivity should be done
in order to determine the bacterial agent and which antibiotics will be most effective in eliminating the infection. If no improvement
is noticed after 4 weeks, a change in antibiotic is recommended.

If attempts to clear the infection with antibiotics appear to be failing, your veterinarian may suggest ear surgery to be able to obtain
a sample for a culture and sensitivity, to remove exudate, and to provide drainage. Antibiotics need to be withheld for 3 days prior
to obtaining a culture. One treatment includes leaving a drain. However, the pus that rabbits produce is frequently very thick and
does not drain.

If the head tilt is extreme, a steroid may be prescribed in an attempt to reduce the inflammation. If the rabbit is not eating or
drinking, the doctor may recommend that fluids be administered subcutaneously and food given orally by syringe.

Although middle and inner ear infections reportedly have a poor cure rate, there are still many cases of success in getting rabbits
through this illness. The "secret" is long term antibiotics, frequently a minimum of 30 days. However it may be necessary for a
rabbit to be on antibiotics for 6 months or even for the remaining years of his life. This treatment in conjunction with a loving and
supportive environment can provide the rabbit with a good quality of life even if the disease cannot be completely eradicated.

Stroke is usually suspected on the basis of physical signs. Imaging to diagnose this problem is available to humans but difficult
to arrange for companion rabbits. As in humans, acerbrovascular accident can kill, but if it does not, then the rabbit may initially be
left with one side of his face, and perhaps one entire side of his body affected. One side of his face will droop, he may drool, and
one eye may not function properly. He may not move normally or may move in circles. Function usually will slowly return over a
period of months.

Care for a bunny who has suffered a stroke involves nursing him through his difficulties in eating, drinking and moving. Antibiotics
do not help these cases, but sometimes are given to help rule out infection. Acupuncture should also be considered in treatment
of these cases.

A blow to the face, neck or head can result in an injury to the brain which can cause the rabbit to have a head tilt. Trauma even
could result from a panic reaction. Depending upon the severity of the trauma, an anti-inflammatory might be helpful to speed

Tumors occurring in the brain, neck or ear could produce a symptom of head tilt.

Cervical muscle contraction
A "muscle spasm" could cause a temporary head tilt. This situation will resolve itself once the muscle is relaxed.

E. Cuniculi
Encephalitozoon cuniculi, a protozoan parasite, can cause brain disease (meningooencephalitis and microscopic cysts), and can
result in paralysis anywhere in the body, since every part of the body is controlled by a specific part of the brain. Frequently there
are signs preceding a head tilt caused by E.cuniculi such as tripping, dragging of feet, tipping over. These symptoms may have
appeared and then vanished weeks or months prior to the head tilt. A blood test for antibodies to E. cuniculi can tell whether your
rabbit has been exposed.

This could be caused by ingestion of lead, found in paints or imported pottery, or ingestion of a toxic plant.

Caring for a rabbit with head tilt
Regardless of the cause, most cases of head tilt have similarities.

The "down" eye (the one facing the floor) will usually not close and will require eye ointment to keep the eye moist.

Lack of balance is what causes rabbits to "roll" and be unable to stand, so pick them up as little as possible. When you must pick
your rabbit up, hold him securely against your own body, to help him feel as stable as possible. Depending upon the size of your
rabbit you can usually figure out how to confine him to a smaller space. Place one of the synthetic sheepskin rugs (that allows
urine to pass through but will keep the bun dry) on the floor of the cage or box, and then place rolled towels or small blankets to
help prop him up, so that he will be less likely to roll when he loses his balance. A stuffed toy bunny friend also helps.

Most rabbits will keep eating but may need to be hand fed with lots of sympathy with every bite of food. He may not want his
pellets, but he will usually eat a variety of fresh green veggies and fruits if you hold them for him. Also offer hay to encourage him
to eat lots of roughage.

If your rabbit decides to decline food, you will have to be ready to syringe feed. Baby food (pumpkin, apple but nothing with added
sugars, milks or meats) is fine. The primary point is to get food into the stomach so that the gut doesn't stop moving, which would
add further complications to the process of getting him well. You could also try a recipe made of pellets mixed with 2 parts water,
mixed garden baby food, some banana, some powdered acidophilus, some apple sauce (some of whatever your bunny likes that
has a strong taste). Feed as frequently as possible throughout the day, and as much as you can get down at each feeding. If your
bunny clenches his teeth and won't swallow, stop for a while and try more later.

An alternative therapy that is getting excellent results for rabbit head tilts is acupuncture. Of course, this treatment is to be
administered only from experienced vets but it can work miracles over a course of treatments. Acupuncture treats muscle pain &
For more information, please refer to these websites.
Excellent rabbit medical
This is Dingleberry receiving acupuncture
for her head tilt. Dingle's tilt was positively
identified as an inner ear infection.
Dingleberry has now had her head tilt for four years! Dingy is now eight years old and now resides in our bedroom next
to Nimal's side of the bed (she's a daddy's girl!!). Dingy likes to know that her home is constant. She doesn't like too
much change around her so if her home & her things remain in the same place, she is a very contented bunny.

Four years on, Dingy still uses a large flat plastic container lid as her litter tray (we lay newspaper on it & then hay).
Apart from her sideways disability, she is still the happy bouncy bun she was before her inner ear infection.

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