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Otitis media/interna and encephalitozoonosis are the most common causes of head tilt in pet rabbits in the UK: 73 cases (2009-2020)

Liatis, T; Makri, N; Czopowicz, M; Richardson, J; Nuttall, T; Suñol, A


T Liatis

N Makri

M Czopowicz

J Richardson

T Nuttall

A Suñol


BackgroundThere are limited studies that identify diseases associated with head tilt in pet rabbits.MethodsThis was an observational, retrospective, single-centre study of rabbits with head tilt presented between 2009 and 2020. Descriptive statistics were performed for all cases, whereas univariate and multivariate analyses were only performed for the 36 cases with a final diagnosis.ResultsSeventy-three rabbits met the inclusion criteria. The final diagnoses included Encephalitozoon cuniculi meningoencephalomyelitis (EC) (15/36; 41.7%), otitis media/interna (OMI) (8/36; 22.2%) and concurrent EC and OMI (13/38; 36.1%). Subacute-to-chronic onset was more common in rabbits with OMI than in those with EC (p = 0.018). Previous middle ear surgery (p = 0.046) and a diagnosis of otitis externa (p = 0.004) significantly increased the risk of OMI. Meloxicam was associated with improvement of clinical signs (p = 0.007). Upright ears (p = 0.013), recumbency (p = 0.037) and impaired mentation (p = 0.001) were associated with a higher risk of death/euthanasia. The proportions of residual head tilt (66.7%) and relapse of vestibular signs (42.1%) were high.LimitationsThis was a retrospective study with cases varying in their investigation and conclusive final diagnoses.ConclusionOMI and EC were the most common aetiologies of head tilt in pet rabbits in the UK. Meloxicam might be associated with a favourable outcome in affected rabbits. Paired EC serology and a CT scan of the head should be the baseline investigation for head tilt in rabbits.


Liatis, T., Makri, N., Czopowicz, M., Richardson, J., Nuttall, T., & Suñol, A. (2024). Otitis media/interna and encephalitozoonosis are the most common causes of head tilt in pet rabbits in the UK: 73 cases (2009-2020). Veterinary Record,

Journal Article Type Article
Acceptance Date May 3, 2024
Publication Date 2024
Deposit Date Jun 10, 2024
Publicly Available Date Jun 10, 2024
Print ISSN 0042-4900
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed


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