Typically, if a bunny is having seizures, vets will simply treat for EC and an infection. So Panacur and an antibiotic. You can add a NSAID too for inflammation. EC tests are notoriously unreliable.

Seizures do point to EC and as LBJ says, EC tests are not very good. Maybe you could ask if you can treat with Panacur anyway. (It’s a slow acting drug so you’re unlikely to see rapid improvement.)

An inner ear infection (or, rather, middle ear infection, technically) doesn’t always have to be visible from the outside, although sometimes the vet can see the eardrum bulging. Lops are a huge lot more prone to ear infections than up ears rabbits, they often have very narrow ear canals and it can be difficult for the vet to get the otoscope in there and get a good view. (Up ears buns can get ear infections too, but they’re nowhere near as prone as lops). With an ear infection, the facial muscles are often affected, it can look like the bun has a little smirk on its face. If you look at Louise’s face from straight ahead, do you see any differences between her two facial halves? Does she seem heard of hearing?

I agree with the others, many vets will treat for EC as a precaution as the tests can be unreliable. Sometimes results are seen in as little as a week or two, but sometimes it takes nearly the full course. An anti-inflammatory can be given along with Panacur because some of the symptoms can be due to the inflammation caused by the infection. I think with the scratching at the ear it also isn’t unreasonable to suspect and ear infection. It’s odd they couldn’t give you a straight answer about the ear infection, do you think it could be good to get a second opinion?

There can also be causes where tooth roots can be overgrown to the extent that they impact the ear and cause symptoms like this, which could be why she wants to do the head x-ray. I would ask the vet specifically what she would be looking for with the x-ray, and if there is any harm in waiting to see if the other treatments work. If there is something time sensitive she wants to check for (such as an abscess), that would justify doing the x-ray right away.

According to a vet webbinar I attended in 2021, middle ear infections, past or ongoing can be seen on X-rays. The vet can see if the bullae (structures in the ear that aren’t visible from outside the ear drum) are intact or if they are destroyed by an infection. So that may be one reason why your vet wants to do head x-rays.

As Dana says, rabbit teeth can become very long and grow into the structures outside the jaw bone. this can occur both in the upper and lower jaw. It can happen if the rabbit teeth for some reason don’t wear like they should. In short-faced, stub-nosed rabbits it’s often a malocclusion problem due to the fact that there’s just not enough space in the mouth for all the teeth, but there can be other causes as well. Teeth that grow like this can be seen on x-rays, as can signs of infection or abscesses around tooth roots.

Any update on this? I apologize, my initial response was on my phone. I do think that if you’re not getting answers from your vet, then it may be time for a second opinion. There are things that can be done without definitive diagnosis. Sometimes you just have to go by the symptoms and see if the treatment helps. In the case of EC, giving a bunny a course of Panacur isn’t going to cause harm if it turns out it isn’t EC.