Article (unless otherwise stated) by Abigail Edis FdSc RVN CertVNES CC Exotics veterinary nurse.
Head tilts in guinea pigs are surprisingly not uncommon, and over the years I have seen many piggies with a tilted head. This months article is here to help you understand the potential causes of this issue in piggies and how to treat it.
To know more about why the head tilts it is important to have some understanding of the balance centre in the ear and the brain. Hopefully, Kim’s article on The Guinea Pig’s Sense of Balance on pages 46 – 48 sheds some light on this critical neurological function. Head tilts usually go hand in hand with poor balance.
When a piggy suffers from a tilt (especially one which has come on quickly) they can have issues walking (called ataxia), often stumble, circle and fall over. In some severe cases they may roll over, often several times to try to right themselves, we see this in rabbits with extreme head tilts. Some may stop eating or struggle to eat, but with support, many can do well. When guinea pigs have a head tilt it can be described as a result of a central neurological disorder (this means it derives from the brain) or peripheral disorder (which means anything outside the brain). So what is the difference you ask?
This means something that has happened in the brain to cause the head tilt. And there are a number of things in the brain which could be at fault here. A common misconception is that head tilts are commonly caused by a stroke but this isn’t usually the case. Unless the brain stem has been effected, if it is a brain issue, it is most likely because of one of the following:
+ A head trauma (a fall or blow to the head)
+ A brain lesion (a mass or growth in the brain)
+ An infection of the fungus E.cuniculi – a common problem in rabbits
+ A genetic disorder, most commonly the lethal gene can cause inherited head tilts
The only peripheral disorder which can account for a head tilt is a problem with one or both ears. The ear is a complicated structure, and infection is the most common cause for problems with the ears. Infection once tracked into the middle or inner ear, can disrupt the balance centre. Bacteria can get into the middle or inner ear via several routes these include:
+ Infection tracked from the external ear canal
+ Infection tracked up the Eustachian tube from the upper airway (back of the throat/nose) common in guinea pigs suffering from respiratory issues
+ Sometimes the underlying ear infection origin is never found or known.
What to do if my piggy has a tilt?
This condition can be quite shocking for an owner if they come across a piggy who has suddenly developed this problem, especially if they are unable to move well. It is best to seek veterinary attention as soon as possible. The sooner care can begin the better, although it is not a dire emergency, it is best to have them seen promptly.
Treatment for this problem will depend on some other signs too, for example, if they have discharge from their ear, then it is almost certainly an ear infection, however with this absent it can be a bit of a process of elimination.
Your vet may wish to perform a few diagnostic tests to rule in or out what the leading cause is. I cannot advise what is the best practice in each case as every patient is very different. However, some things which they may advise are:
+ X-rays to check the inner ear (Bullae)
+ A CT scan to image the ears in much more detail
+ A blood test to check for E.cuniculi
+ An MRI scan could be performed in cases of more central problems; however, this scan is costly.
+ If puss is present, then a swab of this to check what bacteria is growing to ensure the correct antibiotics are used.
Treatment often involves a number of different things; these will vary but are often:
Pain relief: When it comes to treatment, the first thing I would ensure your piggy receives is pain relief, in some cases, more than one type too. Even if the cause of the tilt is not found, most (though not all) of the conditions listed above are likely to be painful in some respects, and if anyone has had an ear infection, I am sure you can vouch for the terrible extreme pain it can cause.
Home support: If unsteady on their feet, then changing their home is very important to help with their mobility. Ensure that you keep your piggy to one level (no ramps or ledges). Ensure that you line their cage with a soft substrate which is easy to move on, something like towels or fleece may be easier than a deep bedding of hay. If need be, they may need respite from companions, either for a few days or periods, especially to eat without competition.
Antibiotics: If an ear infection is considered the cause, then a very long course of antibiotics will be needed to clear an infection, this is due to it being in a difficult place in the body for antibiotics to penetrate. This may include more than one type if the infection is bad and will likely be many weeks long.
Feeding support: In some cases, a piggy may not be eating well or not be eating at all. In this case, supplementary syringe feeding is an absolute must to prevent gut stasis, weight loss and malnutrition. Gut stimulant drugs may also be necessary in some cases.
Anti parasitic treatment: If the cause is entirely not know or it’s considered that the brain is involved, then a 28-day course of a drug called Panacur may be given to cover for e.cuniculi. This fungus (which used to be classified as a parasite) affects the brain and kidneys. Panacur is used to treat an active infection when signs of this are seen.
Other options: Anti-vertigo medications can be given, which can help ease the feeling of the world spinning. In severe cases of ear infections, then sometimes surgery may be advised too. Please note that steroids should never be used for this condition (or any others in guinea pigs) – they are commonly used in cats and dogs with ear issues. Guinea pigs are highly sensitive to the immunosuppressive effects of steroids, and they should be avoided at all costs in these species, including topical ear and eye drops with steroids. Often guinea pigs will develop deadly pneumonia from the effects of this drug.
Mumma’s multi-resistant ear infection
Having had a piggy with a head tilt of my own recently, I thought I would share her little story of recovery. Mumma had a poor start in life, she was used as a breeding sow for skinny pigs but indeed landed on her paws here with me after being rehomed from the lovely Sarah at Hazelcroft guinea pig rescue. She is quite a matriarch of the rescue herd I have at home, and will readily tell the others who is boss.
Sadly, back in late summer 2019, Mumma developed a very sudden head tilt. She was prescribed pain relief, antibiotics, anti-vertigo medication, Panacur and plenty of support at home. At her worst any movement or picking her up would cause her to crocodile roll due to being so disorientated – not an uncommon sign in severe cases but very distressing to see for an owner. Mumma thankfully improved and subsequently had a six-week course of antibiotics. Her tilt never 100% resolved but she remained in good spirits and eating well. However, six months later in early 2020, she had purulent discharge from her ear and a noticeable polyp in her ear canal. Bingo – we finally had a cause.
This time, with puss present, we took a culture swab of it to send to the laboratory to grow bacteria to find out the cause and what antibiotics she needed. Although her tilt was not much worse, her ear was very painful, and at one point, we placed her on three lots of pain relief to help combat it. Her swab came back as multi-resistant to several antibiotics. This made the infection a stubborn one. Sadly bacteria are becoming more resistant to antibiotics due to their overuse and being prescribed too often, patients not taking the full course, and antibiotics in factory farming. It is sadly a leading threat to human life. Guinea pigs are also tricky as they are quite sensitive to many antibiotics too, so it was hard to combat the infection with both an antibiotic that was sensitive to the bugs and safe to use in piggies.
After a few weeks of unsuccessfully fighting the infection, we gave her a brief anaesthetic and removed the polyp in her ear and flushed it all out, yet still, the infection would not shift. After reviewing her case and discussing with the vets, poor Mumma ended up enduring injections of an antibiotic called Oxytetracycline twice daily for ten days. This drug was safer and more effective to give by injection form even though it is safe to give guinea pigs. Its is safe to say that Mumma and I were not best friends during this time, and I felt like I was torturing her with twice daily ear flushes, antibiotic ear drops and painful subcutaneous injections on top of her oral pain relief medications. However, perseverance paid off, and after a month of battling her ear infection, it finally resolved, and her ear was clear.
Her head tilt does remain, but, she likely has permanent damage to her nerves. She has facial nerve problems on the left side of her face including a slower blink and slight squint to the eye that side, in all likelihood she will be deaf in the left ear too. However, her imperfections make her even more of a character. I am very thankful to have run a culture swab on her ear and have an amazing vet team behind me to look after my guinea pigs. Otherwise, I would have spent longer than a month trying to fight the infection. I hope this topic has given you a little insight into head tilts in our furry friends and it helps you understand them more should you have to deal with one in the future.