Diagnosing otitis media in rabbit (with rads)

Re: Diagnosing otitis media in rabbit (with rads)

Glenn Hodgson — Sun, 23 Nov 2014 09:30:46 GMT

Apparently.you can ultrasound scan middue ears in rabbit and is better than rads. I have never tried.

May have been skim reading/stating obvious but has the rabbit had a course of ivomec yet?

Re: Diagnosing otitis media in rabbit (with rads)

Ashley Sykes — Sat, 22 Nov 2014 21:00:57 GMT

[quote user="Luciano Nebiante"]

Just wondering if video-otoscopy would be helpful in such cases.

[/quote]

Definitely, I struggle to get down to the base of these massive ears!

[quote user="Marie Kubiak"]

[quote user="Ashley Sykes"]

The owner reports that the bunny has on and off days still, and that it responds very well to metacam - if used every 3 days or so the bunny seems to do very well. What do you think about using long term (albeit only q 3-daily or so) metacam (0.3mg/kg) for control given the limited options?

[/quote]

I don't think intermittent low dose metacam would be the best option - the owner is likely only seeing the breakthrough more marked discomfort and the chronic status isn't being managed. I would suggest if being conservative then 0.3mg/kg bid would be the way to go if palliation is the aim.

Marie

[/quote]

Thanks Marie, I think it's leaning towards more palliative care....

Re: Diagnosing otitis media in rabbit (with rads)

Marie Kubiak — Tue, 18 Nov 2014 17:15:05 GMT

[quote user="Ashley Sykes"]

[/quote]

Marie

Re: Diagnosing otitis media in rabbit (with rads)

Luciano Nebiante PGCertSAS — Mon, 17 Nov 2014 16:51:53 GMT

Just wondering if video-otoscopy would be helpful in such cases.

Re: Diagnosing otitis media in rabbit (with rads)

Ashley Sykes — Mon, 17 Nov 2014 11:00:36 GMT

Thanks again for the reply Marie, sorry for my delay.

I did try and ultrasound but without a lot of success. I may try again with our sister-practice's ultrasound which is a little newer and better! I think unfortunately CT is just not do-able but would be so helpful!

Re: Diagnosing otitis media in rabbit (with rads)

Marie Kubiak — Mon, 10 Nov 2014 19:29:24 GMT

Unfortunately a negative swab doesn't tell you anything. Even a healthy ear should have some bacteria so failure of growth doesn't suggest a normal ear.

I think you need some more imaging before you can decide on the best course of action. As you already know CT scan is ideal but if not possible then you could try ultrasound to see if there is fluid/debris in the bullae to guide you as to whether there are changes and if they are bilateral.

Most importantly though how is the bunny? That will be key in how aggressive you are going to need to be.

Marie

Re: Diagnosing otitis media in rabbit (with rads)

Ashley Sykes — Mon, 10 Nov 2014 11:59:33 GMT

Marie: (or others!)

The culture and sens of the external ear came back negative, nothing grown, despite being a good swab. This probably supports more inner ear true disease and just outer inflammation?

We therefore did 6 weeks (non-targetted) septrin and meloxicam as/when necessary. He certainly improved over this time although still had the occasional "bad" day.

On re-exam after this treatment inflammation was clearly still present in the canals. It has switched from L worse to R worse now: in the R ear there is almost an inflammatory polyp which was not present before. I am afraid I could not get a good picture of it! The ears are still hot to the touc.

Any further advice? The owner is willing to do surgery if necessary but would rather avoid I feel - bunny takes a long term to recover from anaesthesia (days to be eating 100% properly).

Thanks again.

Re: Diagnosing otitis media in rabbit (with rads)

Ashley Sykes — Sun, 07 Sep 2014 19:26:35 GMT

Sorry, yes it is!

Yes the TM's are visible, but only just. The left canal has some mild stenosis, the right normal (but infected). The difficulty in viewing is mainly as my otoscope piece is not long enough in this huge bunny!

Thanks for your opinion, really appreciate it. The owner would be very pleased to not jump to surgery, so your plan of C+S and longer treatment sound great, and avoiding topicals sounds good too!

Thanks again I will relay this and see how we get on.

Re: Diagnosing otitis media in rabbit (with rads)

Marie Kubiak — Sun, 07 Sep 2014 09:22:27 GMT

Is this a lop? given the size and likely breed I'm assuming so. If not then the below may not strictly apply as anatomy strongly affects ear disease.

If you can see tympanic membranes then the canals must be fairly clear and open which suggests the external component is mild. The radiographs do suggest some chronic change in the bullae but the difficulty is that this may be archaic. As you say, CT is gold standard for assessment but even that has limitations in assessing clinical relevance.

I would be hesitant to go for surgery at this stage especially as post-op complications, if they occur, will be worse than the symptoms you are trying to treat. At this stage I would consider culturing the external ear (not ideal as may not reflect any internal infection but better than blind treatment) and treating systemically based on this for at least 4 wks (I usually treat for 6-8wks but this depends on clinical response and tolerance of antibiotics). I don't like using topical meds in rabbit ear cases as they tolerate treatment poorly, many preparations are contra-indicated with the addition of steroids, leakage into the middle ear will exacerbate discomfort and any middle ear component is not addressed.

This is unlikely to be a cheap, quick fix so prepare her for ongoing treatment and don't try and cut corners as a favour as you will be the one who takes the flak if expectations aren't met.

Marie