📚 Understanding Otitis Media & Interna

Otitis media is infection of the middle ear, while otitis interna involves the inner ear and vestibular system. In rabbits, these often arise from unresolved ear mites or external infections, and can lead to serious issues like head tilt, balance problems, and facial paralysis .

⚠️ Why It Matters

• Middle ear infections can escalate into inner ear disease, affecting hearing and balance.
• Without prompt treatment, infection may spread to the brain or cause permanent nerve damage.
• Signs are often subtle—chronic head tilt or circling may be misinterpreted without medical evaluation.

👀 Recognizing Clinical Signs

• Persistent head tilt, leaning, or circling behavior.
• Noisy head shaking, rubbing ear base, or facial asymmetry (drooping whiskers/eye).
• Vision problems, nystagmus (rapid eye movement), hearing loss, or decreased appetite.
• Absence of obvious external ear signs—no discharge or visible pain, because infection is hidden .

🔍 Diagnostic Approach

• Medical history & exam: Note any ear scratching, prior external ear issues, or system illness.
• Neurological evaluation: Assess vestibular signs like nystagmus, postural changes, and reflex deficits.
• Otoscopic & endoscopic exam: May appear normal if external canal is clear.
• Imaging: CT scan of head is the gold standard to visualize bulla fluid, bone lysis, or mass .
• Myringotomy or bulla tap: Under anesthesia, collect middle ear fluid for culture and sensitivity.
• Bloodwork: Full CBC and chemistry to check for systemic infection or organ compromise.

🛠️ Treatment Options

A. Medical Management

• Administer long-term systemic antibiotics (e.g., fluoroquinolones or trimethoprim–sulfa) guided by culture—usually 6–8 weeks.
• Manage inflammation and pain using NSAIDs.
• Continue periodic ear flushing if needed via myringotomy.
• Provide supportive care: hydration, environment enhancement, and vestibular rest.

B. Surgical Intervention

• Lateral bulla osteotomy (LBO): Removes infected bulla contents and flushes middle ear; often combined with TECA if external disease present .
• Place antibiotic-impregnated beads for sustained local drug delivery.
• Facial nerve may be temporarily affected; expect gradual recovery.
• Post-op care includes analgesia, regular flushing, and monitoring.

C. Management of Interna Disease

• Focused treatment on media infection.
• Support vestibular function with fluids, cage padding, and syringe-feeding as appetite returns.

🏠 Home Care & Monitoring

• Ensure rest in a padded, safe enclosure to prevent falls.
• Assist feeding for rabbits with severe tilt; adjust diet to encourage intake.
• Administer medications consistently and monitor for adverse effects.
• Encourage gentle movement as balance improves; monitor for recurrence.
• Schedule follow-ups: imaging 4–6 weeks post-treatment; ear rechecks every 2–3 weeks.

📊 Prognosis & Outcomes

• Medical treatment alone may succeed in mild-to-moderate cases.
• Surgery with culture-guided therapy provides best outcomes; some rabbits may retain mild head tilt long-term.
• Untreated infections risk relapse or spread to deeper structures—can be life-threatening.

🛡️ Prevention & Risk Management

• Examine ears routinely during wellness exams—especially in lop-eared breeds.
• Treat and control ear mites and external canal inflammation early.
• Ensure ear canals stay dry and cleaned when necessary.
• Link chronic external issues to proactive screening for middle/inner ear disease.

🧠 Vet Tips for 2025

• Promote CT imaging for suspected media/interna disease over reliance on radiographs.
• Explain the need for extended antibiotic courses to owners during consultations.
• Utilize telehealth between visits to monitor recovery and guide supportive care.
• Educate clients on signs of recurrence—tilt, appetite drop, or head shaking.
• Collaborate with specialists for surgical cases or diagnostic imaging access.

🔚 Final Takeaway

Otitis media and interna are serious but treatable ear conditions in rabbits. In 2025, veterinarians should combine early detection, advanced imaging, culture-based therapy, and surgical approaches when needed. With diligent monitoring and management, rabbits can recover hearing, balance, and alertness—and continue to enjoy happy, healthy lives. 🐇❤️

🌟 Partner Services

• Ask A Vet: Telehealth ear sound analysis, antibiotic guidance, post-op support tools.
• Woopf: Ear care recovery packs—flush kits, protective bedding, post-surgery comfort tools.
• Purrz: CT referral coordination, medication reminders, vestibular support trackers.