Head Tilt In Rabbits

Although Poppy had head tilt, she eventually adjusted to the new normal and lived a normal life.
Photo by Dustin Yoder taken at BunnyLuv Rabbit Resource Center.

Whether the disease comes from the inner ear, the brain or both locations, it is difficult for veterinarians to diagnose the exact cause of head tilt. These affected areas are not easily accessed, and therefore, figuring out the exact cause can only be determined post-mortem.

However, blood work, x-rays, CT scans, MRI and a careful physical examination are useful to pinpoint the most likely cause. Since the problem is usually a bacterial and/or E. cuniculi infection, many veterinarians will aggressively attack with a broad spectrum of antibiotics to kill both aerobic and anaerobic bacteria as well as fenbendazole (Panacur) to control the E. cuniculi. An NSAID, such as meloxicam (Metacam), will often be prescribed to reduce inflammation and provide pain relief. Steriods are typically not recommended as rabbits are very susceptible to the side effects, however, in rare and extreme circumstances, it may be helpful. Meclizine, which is an anti-nausea drug sold OTC as a motion sickness medication, can also be used. Whether a rabbit truly feels nausea or gains a benefit from this medication is unknown, but it can be safely administered.

The "down" eye (the eye pointing towards the ground) is more prone to injury and drying out. Eye lubrication is necessary.

Supportive care, such as syringe-feeding and administering fluids, may also be necessary, especially in the first few days of the disease. How often and how long supportive care is required depends on the bunny and the severity of the illness. 

Long term antibiotics is essential. The minimum should be 10-12 weeks, however, you may need to administer medications for several months. Since there are few blood vessels traveling to the inner ear, it can take a long time for antibiotics to be effective. If there is no noticeable improvement after the first month, your veterinarian may switch antibiotics. Usually pain medication, fluids and Panacur are not intended for the entire treatment. Again, your veterinarian will determine the best therapy plan for your bunny.

At the initial onset of the disease, the bunny should be in a smaller space, such as a 2x4 exercise pen with the sides of the pen padded with rolled up towels. This is so the bunny doesn't have to move as much and it limits how often he rolls. However, as soon as the bunny shows signs of being stable, he should be encouraged to exercise as much as possible. The additional movement will help strengthen his sense of balance.

With appropriate treatment and care, a head tilt bunny can recover enough function to live his life normally. Even if permanently tilted, these bunnies can resume jumping into litter boxes and running down a hallway without danger of losing balance  and rolling.

For more information, read Caring for Head Tilt Rabbits.