Bumble was admitted for investigation. He was housed alone, as his companion had died and he was used to being housed alone. He was placed in a high kennel away from predators to reduce stress. A hide and pheromone sprays were also used to reduce stress. He was settled and calm in the kennel environment.
Radiography identified a radiopaque tympanic bulla( Figure 2). The clinical signs and diagnostic tests indicated otitis interna and media. Due to the breed ' s disposition, it may have been appropriate to consider the link between ocular and aural signs at this point. Referral for CT and surgical intervention was discussed; however, medical management was indicated due to the patient ' s advanced life stage and previous history of severe anorexia for several days following previous sedation or anaesthesia.
Discussion and evaluation of the nursing care
The patient had analgesia throughout his treatment plan, but when otitis interna was suspected a multimodal approach with additional analgesia would have been beneficial.
Culture and sensitivity testing of the aural discharge would have identified appropriately sensitive antibiotics but in rabbit abscesses the thick pus is often surrounded by a fibrous capsule, which often makes systemic antibiotics ineffective without surgical intervention.
The case highlights the link between ocular disease and aural disease, but not until further clinical signs were present was this diagnosis reached in this case.
It also calls attention to the importance of owner education and knowledge of breed-associated disease [ 4 ]. This will allow for faster diagnosis and surgical intervention in appropriate cases, which could improve outcomes.
This case also underlines the dangers of selective breeding and the importance of promoting welfare to aid in the reduction of selective breeding.
Conclusions
Figure 2. Radiopaque tympanic bulla in a rabbit.
The patient was discharged and was bright, eating and able to continue with his normal activities at home, including the ability to‘ binky’. However, in the following days Horner ' s syndrome was observed, with worsening ataxia.
The patient was presented to the practice with suddenonset anorexia. The practice ' s gut stasis protocol was put in place, including fluid therapy, multimodal pain management and prokinetic drugs. Pain scoring was used to monitor the efficacy of analgesia.
The number of rabbits with aural disease is likely to increase due to selective breeding. The use of multimodal analgesia alongside pain scoring could help make these patients as comfortable as possible.
It is important for the veterinary team to help owners understand the importance of regular check-ups for predisposed breeds and increase owner understanding of the potential complications and health conditions these animals may face.
Many practices now offer pet health clubs with 6-monthly checks; these could be used to encourage better owner compliance and early identification of indications of disease.
Different foods were offered to the patient, such as his favourite treats and grass. Syringe feeding of Oxbow Critical Care was indicated, and he tolerated this well. Faecal output and consistency were also monitored. He was housed in a quiet area in kennels to reduce stress and encourage him to eat independently; hides were also provided. Pheromone sprays were used in an effort to reduce stress. Unfortunately, no improvement was seen, so the owner opted for Bumble to be euthanised, as his quality of life was compromised.
44 Veterinary Nursing Journal