Both medical and surgical management of ear disease are indicated; however, the choice will be based on the severity of the condition. The most common surgical technique is a partial ear canal ablation and bulla osteotomy. These are often marsupialised( a surgical technique that leaves a permanent hole for drainage) to reduce reoccurrence and enable flushing of the ear [ 1 ]. Extensive flushing is required over a prolonged period, so owner compliance is key.
The surgical approach of partial ear canal ablation and bulla osteotomy may be recommended over lateral wall resection or the more involved total ear canal ablation [ 4 ]; however, this will be at the veterinary surgeon ' s( VS ' s) discretion.
If flushing of the ear is indicated, it is advisable to assume the tympanic membrane is unlikely to be intact, and therefore physiological saline should be used [ 3 ].
If ear mites are present, all bonded individuals should be treated, along with the environment. Use of antiparasite injections or spot-on treatments is indicated, and multiple applications will be needed [ 2 ]. Leaving the thick crust that is often present with ear mite infection is recommended as removal can often lead to further pain [ 3 ]. Reducing pain is indicated, to reduce the likelihood of gastrointestinal stasis.
Use of ear cleaners and regular check-ups for ear disease is recommended, especially in lop-eared breeds, to aid in the prevention of chronic ear disease.
Pain considerations
It is important to remember that rabbits are prey animals; they are stoic and may not outwardly exhibit signs of pain. Therefore, use of pain scoring specific to rabbits is indicated, with consideration given to how a rabbit may express pain dependent on its source.
Facial pain indicators are useful but somewhat subjective and may lead to other expressions of pain being missed. Validated behavioural-based pain assessment schemes in rabbits have demonstrated that the behaviours and postures considered indicative of pain are predominantly specific to the type and location of the potentially painful location [ 5 ]. For example, if a rabbit has a painful abdomen, they may have a hunched posture rather than a facial grimace. It is preferable to assess the whole patient and consider how these results may indicate pain expression. If a full assessment is not made, the efficacy of pain scoring is reduced.
Non-steroidal anti-inflammatory drugs( NSAIDs) may be appropriate for ear pain at high dose ranges [ 4 ], but if these are not effective then a multimodal approach may be beneficial, including drugs such as gabapentin and tramadol [ 4 ]. Paracetamol is another option but may not be as commonly used due to lack of research.
A study from 2018 into buprenorphine and gut transit time suggests a single dose does not slow down gut transit time; therefore, this may be an appropriate analgesic for some cases [ 6 ].
Evidence is now available on the use of high-dose analgesia in rabbits; for example, doses of 1.5 mg / kg per day of meloxicam( using a formulation licensed for use in dogs) given subcutaneously or by mouth for 5 days were well tolerated in healthy, hydrated rabbits [ 7 ].
When prescribing effective analgesia, a holistic approach should be adopted by the VS. The use of pain scoring, although subjective, can play a key role in monitoring pain and responses to analgesia. The use of a single team member to monitor the patient and pain score may reduce subjectivity and achieve more quantifiable data. However, this may not be practical, and team training is advised.
Veterinary team and owner education
It is important that veterinary team members are aware of the common diseases affecting specific animal breeds, such as ear disease in lop-eared rabbits, copper storage disease in Bedlington terriers, and disease of the nares and soft palate in brachycephalic breeds.
Owner education is important and clients should be made aware of the problems that may develop, as they may not expect the cost incurred with diagnostic tests such as CT scans and surgical intervention. The nursing team should speak to owners about breed-specific pathology and the signs of common health conditions, for example, identifying dental disease by observing hypersalivation, grimace and reduced food intake.
Veterinary nurses( VNs) should also educate owners on the early signs of aural disease, which could aid in early diagnosis. This could include checking for ear-base masses and visually checking for exudate inside the pinna, ocular discharge and a grimace. It is important to consider that ear disease may also present with ocular signs such as discharge, alopecia and lacrimal stenosis.
Many practices now offer pet health clubs, which often include 6-monthly health checks. These can be beneficial in aiding in earlier diagnosis. For example, many ear-base masses are diagnosed at routine vaccination and do not present with clinical signs [ 4 ].
Owners may already be aware of the potential signs of dental disease and may provide their rabbits with fibrerich diets, chew toys and forage enrichment to aid in prevention; therefore, educating them on indicators of aural disease could also be beneficial. Owners can lift the pinnae and look for discharge and feel for ear-base masses. Some clients may also be able to undertake regular ear cleaning to reduce the build-up of cerumen, which may reduce the risk of severe ear disease.
42 Veterinary Nursing Journal