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Hole in the Head Disease
This page contains information about a fish disease called Hole in the Head that sometimes infects large Oscars, other big Cichlids, Gouramis, and other Tropical Fish.
Here is a picture of a large Buttikoferi Cichlid with Hole in the Head Disease. This picture was sent to us by William of Michigan.

Customer Comments

... that fish is a  Buttikoferi Cichlid
Shane B.
Reply. Hello Shane. Thank you for your email. We agree with you. The fish in the picture, shown above, is a Buttikoferi Cichlid from West Africa not a Green Terror from Central America. Thanks again.
1. Hole in the Head
is a disease of Tropical Fish which starts with smalls sore on the head above the eyes. These sore grow and eventually penetrate through the outer layer of skin.

Hole in the Head is most often seen in large Cichlids or other large fish. Oscars are large Cichlids and are often infected with Hole in the Head. Click here for more information about Oscars. Jurupari Earth Eaters, are a species of Cichlid that also often show signs of Hole in the Head.

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2. We think Hole in the Head ...
is the result of poor water quality over a long period of time. It's best to prevent Hole in the Head by doing the proper maintenance schedule. Click here for more information about a Maintenance Schedule.
3. Hole in the Head often occurs ...
in aquariums with under-gravel filters, and sometimes in aquariums with canister filters, but rarely in aquariums with a BIO-Wheel filters. Click here for more information about all of these types of Aquarium Filters.
4. How to Treat Hole in the Head ...
you should immediately begin the recommended Maintenance Schedule and get the properly size aquarium filter with a BIO-Wheel. Then begin cleaning your gravel with a gravel washer. When the gravel is clean, remove most of it and remove the undergravel filter. Click here for more information about gravel and gravel washers. 
5. If you have an Oscar, ...
be sure it has a large enough aquarium. One large Oscar 8-inches in length needs at least 80-gallons of water. Two 8-inch Oscars need at least 150-gallons of water. More Oscars and larger Oscars need even bigger aquariums with more water.
6.  If you have an Oscar or other large fish with Hole in the Head, you should give that fish all six steps of the Recommended Treatment. Click here for the details about the Recommended Treatment.
7. However, the Recommended Treatment usually will not cure Hole in the Head. It's worth a try, and it may work, or it may arrest the disease, so the fish can survive.

The combination of Flagyl (metronidazole) and Chloramphenicol (Chloromycetin) usually does work to cure Hole in the Head. But these are both pharmaceutical drugs that require a prescription to obtain.

At one time you could buy medicated flakes, and one type of those flakes contained these two drugs. But I haven't seen any of the medicated flakes offered for sale in several years.

8.  I have been told that Hole in the Head is caused by a combination of flagellated protozoans and bacteria. Flagyl is a treatment for flagellated protozoans, and Chloramphenicol is a powerful antibiotic.

We do not have any more information about the availability of these drugs or any other drugs.


Customer Comments

Hi, Great site! I am an Oscar owner myself--sadly I must have been doing something wrong b/c at the age of six, about 1 yr after transferring him from a 40-gallon tank to a 75 gallon tank, he succumbed to Hole-in-the-head.
But I have taken my aquarium apart and am currently reestablishing it so that I can raise another. Anyway-I went through many avenues of finding help for Oscar while he was sick--I mainly did water changes, dietary changes (no feeder fish), and Paragon II.
I really don't want this to happen again!!! One owner of a fish store told me that the number one cause of death for all fish was using Windex on the outside front of the tank. Is this true?
I've never heard that anywhere, and I Windexed my bow front about once every two weeks--only the front though. He did not attribute that to the hexamita of course, but he did say that it was deadly. Could reply either directly to me or post something on your website about that?
Thank you,
Reply. Hello Ashley. Thank you for your complimentary comment. We are glad to know that you enjoy this web site.

Sorry to read about your Oscar. The comment about Windex is speculation, but we recommend using only products that are labeled for use in and on aquariums. Click here for more about avoiding contamination.

We recommend that you use the cleaner named Safe & Easy Aquarium Cleaner. Click here to buy it.

Here is some more advice.

(1)  Get two Penguin 330 filters for your aquarium. Click here for more information about this filter.

(2)  Have at most 1/4" of gravel. Click here for more about Aquarium Gravel.

(3)  Do a regular Preventative Maintenance. Click here for more information about a maintenance schedule.

(4)  Buy a very high quality Oscar. Be sure it shows none of the Signs of Stress and Disease. Click here for more about those signs.

(5)  Feed flake food then feed pellets labeled for Oscars. Click here for more about feeding fish.

We hope your experience will help other Oscar Keepers and their Oscars to avoid Hole in the Head Disease.

Books about Fish Disease
The books shown below are listed on You can click on the image of a book to go to the page at, where that book is listed and discussed. In some cases you can preview several of the pages in that book.
Click on this image to go to, where you can learn more about this book.   Handbook of Fish Diseases
By Dieter Untergasser, et al
160 pages
Click on this image to go to, where you can learn more about this book.   A-Z of Tropical Fish Diseases ...
By Peter Burgess, Mary Bailey, and  Adrian Exell
392 pages
Click on this image to go to, where you can learn more about this book. Colorguide of ... Diseases
By Gerald Bassleer
272 pages
Click on this image to go to, where you can learn more about this book. Confessions of a Fish Doctor
By Scott Bodie
Click here for a complete list of books about Diseases of Tropical Fish at
Click here to go to another page in this web site with Customer Comments and our Replies about Hole in the Head Disease.
Click here to continue on to another page in this web site with Customer Comments and our Replies about fish diseases.
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5 Important Aquarium Products

For excellent health, pet fish need very good food and very good water conditions. These five products are very important.

Premium Fish Food Flakes
Premium Fish Food Pellets
DrTim's Water Conditioner
DrTim's WasteAway
Denitrifying Lava Rocks
Click here now to learn more and add one or more of these products to your fish order.
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 Best Selling Books 
  Click here now to order The Simple Guide to Freshwater Aquariums, a bestselling reference, offering an easy-to-understand look at setting up and maintaining a successful first freshwater aquarium.
  Click here now to order The New Marine Aquarium: Step-By-Step setup and stocking Guide, the best selling book about starting a new marine aquarium.
  Click here now to order 500 Freshwater Aquarium Fish: A Visual Reference to the Most Popular Species, a beautiful book, lovingly written and illustrated, with information for the beginner or the longtime enthusiast.
  Click here now to order Fancy Goldfish: A Complete Guide ... by Eric L. Johnson, DMV, and Richard E. Hess. The most encompassing and thorough treatment of the fancy goldfish hobby to date. Hardcover with 176 pages.
Click here now for many more fishy books.
We hope these suggestions help!  ;^ }
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This page was updated on March 11, 2015.