Head Tilt/Facial Paralysis after TECA-BO (no ear infection)

[olliepop_bun]

Hello All,

I have possibly the weirdest scenario a bun could have in relation to ear infections. I’ll fast forward thru the beginning, but basically my holland lop Louie had inner ear infections on both ears and so he went thru the journey of having surgery on both ears. On his left he had a TECA-BO (total ear canal ablation and bulla osteotomy) and on his right a lateral ear canal resection. It’s worth noting that he was also experiencing facial paralysis on his left side before surgery, he could not blink and his lip was hiked up.

He had his TECA-BO done 7 months ago now and it has healed great. Just this last week though, he has started to present signs of head tilt and asymmetric facial paralysis. Both of these are on his left side which is the TECA-BO side. His lip went back to being hiked up and he cant blink very well on that side. He can walk and jump, but if he moves to fast he trips, it is a very mild tilt, definitely not the 90 degree angle kind. Other than that, he acts super normal, eating and pooping well.

I’ve done a ton of reading and I know most of the time head tilt is caused by ear infections, abscesses, or bulla disease. Theres a great article on it which is actually written by Louie’s vet, Dr. Antinoff. (https://www.dvm360.com/view/head-tilts-rabbits-proceedings) The weird thing is it would be impossible for Louie to get an ear infection on that side, because he literally does not have an ear anymore. Also he cant have bulla disease because the bulla was removed in surgery already.

I read that partial facial paralysis and head tilt is a possible complication of the TECA-BO surgery, so I initially thought this is what was happening, but when I contacted my vet she said she doesnt think its related to the surgery at all since its been 7 months and she suggested a CT.

Honestly, I would go ahead and do the CT, but I financially cannot. I’ve already spent close to 8,000$ on Louie’s surgeries and also my dog just this month had a 2,000$ emergency surgery. I’m drowning in vet bills. Personally I find it hard to believe that its unrelated, it would be way too coincidental for him to also have an abscess or tumor on that same side, not related to the TECA-BO surgery.

Does anyone have any thoughts or advice? I’m so lost right now. I know there are some buns that just live with head tilt and are otherwise fine, I think that’s where Louie is, but I dont want him to get worse if there is an active problem that I dont fix.

Thank you

[Wick & Fable]

I shared your post w/ some others to poke some other brains. Some things to consider:

• While there is no traditional “ear”, there are can still other infections and injuries in that general vicinity which can lead to a rabbit tilting their head due to poor sense of balance, discomfort, compensation, etc.
• There is apparently a nerve on the side of the face that’s very susceptible to causing head tilt/ear inflammation
  • it could be worth doing a basic x-ray to see any obvious abscesses and dental disease (i.e., things not actually related to the ear). Again, other things cause head tilt
• If not done already, testing for EC is a good idea

Generally speaking, it sounds like he’s doing well in the context of the new observation, so it doesn’t sound super urgent.

From both personal experience and review of the general rabbit care community, just keep an open mind. I know when I was neck-deep in recurrent ringworm and respiratory infection episodes w/ one of my rabbits, everything I noticed was instinctively viewed through that frame of mind, so both myself and my vet at the time approached symptoms as such. Fast-forward, I moved, went to a new vet for symptoms, and w/ the different, non-biased set of eyes, we treated for syphilis and it really improved Wick’s overall health. So while you’ve done a lot of reading, research, and financial/time investments in the ear-specific surgeries and literature, it’s very possible this is something completely unrelated and it can be worth exercising cheaper diagnostics to investigate first.

The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.

[olliepop_bun]

Hey! Thanks for sharing my post. The more I look at Louie the more I realize how mild his head tilt is. If you had never seen him before you might not even notice it. I’m starting to think maybe his slight tilt is just an effort to deal with the asymmetrical facial paralysis, like he can tell something is off on that side. (He can even jump on and off the couch when he pleases) I’ve read about the nerve you’re referring to, and my vet did say before surgery that there was a possibility of that nerve being effected during the bulla osteotomy, which would cause facial paralysis. I was also doing some reading about TECA-BO surgeries on dogs and cats, and it said that most dogs and cats that had asymmetrical facial paralysis before the surgery would still have it after the surgery. Which would be Louie since he had that symptom beforehand. I’m really hoping this is the case.

I really would prefer to do an x-ray rather than a CT, just because of the cost difference. Are you sure that X-rays show deep tumors/abscesses? Unfortunately, my vet is VERY slow to respond :/

 

[Bam]

The pulled up face does point to facial nerve (cranial nerverve no 7) involvement. 7 months seem a long time though and your vet seems confident it isnt related to the surgery. Sometimes scar formation can cause more trouble than an original injury -if there ever was injury to the facial nerve.

I think I’d look into ec first of all, since it’s a known cause of vestibular disease. Maybe your vet would be willing to prescribe a course of Panacur without extensive testing? Ec wouldn’t typically affect the facial nerve though, even if ec of course could invade any part of the nervous system. It seems more likely that something is putting pressure on the nerve.

[olliepop_bun]

What is EC? I was thinking about doing a test run of meloxicam and an antibiotic, maybe before the CT since it costs over a thousand to have done.

[Bam]

E c is encephalitozoon cuniculi. It’s an intracellular microscopic parasite that’s very common in rabbits. Most rabbits are asymptomatic carriers, but some get ill. Typical findings are head tilt, balance issues and/or hind end paralysis or kidney problems that aren’t due to UTI or sludge. Young buns can get infected already in the womb, a typical sign of that is rapidly progressing cataracts at a young age.

Ec can invade any organ system that has a high bloodflow. There’s still a lot to be known about this parasite. Standard treatment is Panacur (fenbendazole) for 28 days, often in combination with Metacam (meloxicam) to bring down tissue inflammation. Additional meds can be given to help relieve vertigo/ nausea or to improve kidney function (if the kidneys are affected).

A normal x ray can show some tumors. I had a bun that developped a big tumor in his abdomen, that certainly showed on normal x-rays. Buns with suspected uterine cancer often have their lungs x-rayed to look for metastases, because uterine cancers tend to spread to the lungs. I don’t know how good a normal skull x ray would be in your bun’s case.

It could be that your bun’s tilts the head in some sort of “voluntary” effort to compensate for the facial paralysis. Maybe keep monitoring closely for now? It’s a good idea to film the bun so you don’t have to rely on memory. Filming makes it easier to spot more subtle changes.

 

 

[LBJ10]

Bam hit on this a little bit, but another possibility could be permanent damage caused by scar tissue. I had a bunny with permanent facial paralysis from chronic URI’s that eventually migrated to the ear and damaged the nerve. He was treated, of course, but the facial paralysis never resolved.

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