Audio-vestibular disorders and pregnancy: A systematic review

Association between the number of pregnancies and hearing loss: NHANES 1999-2018

BACKGROUND

Hearing loss represents an escalating global health concern with profound implications for individuals and society. While prior studies suggest that reproductive factors may influence women's auditory health, the specific association between the number of pregnancies and auditory function remains inadequately understood. This research aimed to investigate the association between the number of pregnancies and hearing loss in U.S. women.

METHODS

We conducted a cross-sectional analysis of 5,269 U.S. women aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Reproductive health data, including the number of pregnancies, were obtained via self-reported questionnaires. Hearing loss was defined as a pure-tone average ≥ 25 dB HL at speech frequencies (0.5, 1, 2, and 4 kHz) in the better-hearing ear. All analyses incorporated NHANES sample weights. Weighted multivariable logistic regression and restricted cubic spline regression were employed to evaluate the relationship between the number of pregnancies and hearing loss. Subgroup and sensitivity analyses were used to test the consistency and robustness of the association. And mediation analyses explored the roles of white blood cells and high-density lipoprotein in this association.

RESULTS

A total of 5,269 adult women were included in the analysis, of whom 624 (9.81%) exhibited hearing loss. After adjusting for confounders, the number of pregnancies was significantly associated with hearing loss (OR: 1.12; 95% CI: 1.05-1.20; P < 0.001). Conversely, the use of birth control pills was associated with lower odds of hearing loss (OR: 0.67; 95% CI: 0.47-0.94; P < 0.05). Restricted cubic spline regression demonstrated a linear increase in the odds of hearing loss with a greater number of pregnancies. This positive association was consistent across most subgroups. Mediation analyses revealed that white blood cells and high-density lipoprotein partially mediated this association. Sensitivity analyses, including alternative definitions of hearing loss and multiple imputation for missing covariates, confirmed the robustness of the results.

CONCLUSION

Our findings demonstrated that a higher number of pregnancies was significantly associated with hearing loss, while birth control pill use appeared protective. These findings highlight the importance of recognizing potential auditory health implications associated with multiple pregnancies and may inform future public health strategies aimed at supporting women's hearing health across the reproductive lifespan.

Balance control and vestibular disorders in pregnant women: A comprehensive review on pathophysiology, clinical features and rational treatment

During pregnancy, women experience substantial anthropometric, cardiovascular, hormonal and psychological changes that affect several organs involving the circulatory, respiratory, gastrointestinal, musculoskeletal, dermatological and sensory systems. The main aim of this review was to analyse the available literature on postural strategies throughout pregnancy in both static and dynamic conditions. The secondary aim was to assess and discuss the current knowledge regarding vestibular disorders during pregnancy. Pregnant women with vestibular disorders need appropriate and safe treatments to resolve or reduce symptoms without risks for mother and foetus. Our protocol was registered on PROSPERO (CRD42024622122). A literature search was conducted screening PubMed, Scopus and Web of Science databases. After duplicates removal and exclusion of records due to coherence with the inclusion/exclusion criteria, 41 articles relevant to the topic were examined. Although some studies claimed no changes in postural behaviour during pregnancy, most of the available evidence seems to demonstrate significant modifications in posture and balance metrics, with multiple mechanisms. Physiological changes that occur in the mother's body during pregnancy have been considered as a possible substrate for developing vestibular disorders. Dizziness and vertigo were reported in pregnancy in small, low-quality studies. Benign paroxysmal positional vertigo, vestibular neuritis, Ménière disease, vestibular migraine and vestibular schwannoma have all been documented in pregnant women. To overcome reported limitations, prospective studies, preferably multicentre and involving third-level audio-vestibular centres are mandatory in order to define rational diagnostic and treatment approaches for vestibular disorders to protect the safety of the mother and foetus.

Incidence and characteristics of sudden sensorineural hearing loss during pregnancy and the postpartum period: A nationwide population-based study using customized cohort data

PURPOSE

This study aimed to investigate the incidence and characteristics of sudden sensorineural hearing loss (SSNHL) in pregnant and non-pregnant women using the Korean National Health Insurance Service customized cohort data.

MATERIALS AND METHODS

We defined the delivery group as women aged 15-49 years with International Classification of Diseases 10th Revision codes O80-O84 indicating delivery between January 2013 and December 2019. The control group was selected from individuals in the same age range without a history of delivery during the same period. SSNHL was defined as having an H91.2 diagnostic code and having undergone audiometry at least once. The incidence and characteristics of SSNHL were compared between the two groups from 2015 to 2018.

RESULTS

The incidence of SSNHL per 1000 individuals was lower in the delivery group (1.08-1.17) compared to the control group (1.52-1.80) each year. In the delivery group, SSNHL occurred most frequently in the 30-34 age group during the third trimester of pregnancy and the postpartum period. The proportion of patients with SSNHL with comorbidities such as hypertension, diabetes, and dyslipidemia was higher in the delivery group than in the control group.

CONCLUSIONS

Using the longest follow-up period and the largest population in South Korea, we found that pregnancy and childbirth did not increase the risk of SSNHL, which is consistent with the results of previous population-based studies. Our findings provide insights into the etiology of SSNHL and highlight the need for further research to better understand the underlying mechanisms and risk factors associated with SSNHL.

Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy

All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.

Clinical characteristics of sudden hearing loss during pregnancy

Objective

The objective of this study was to explore the clinical characteristics and management of sudden hearing loss (HL) during pregnancy, thus better guiding the clinical practice.

Methods

The clinical and follow-up data of 17 patients (17 ears) with sudden HL during pregnancy were analyzed retrospectively (the observe group). Twelve nonpregnant female patients (12 ears) with sudden HL of similar clinical characteristics were selected as the control group. The prognosis of the two groups was compared. All the patients were followed up after delivery, and two of them were readmitted to the hospital 1-2 months after delivery.

Results

The observe group had better improvement in hearing and a higher response rate compared to the control group. The pure tone hearing and speech recognition rate of patients could still be improved after the readmitted treatment, and the hearing could partially recover spontaneously during follow-up. The laboratory indicators that affect the inflammatory response and coagulation pathway were significantly different between the two groups.

Conclusions

The hearing condition of sudden HL during pregnancy is severe, and the prognosis of these patients is better than nonpregnant patients of similar clinical characteristics. Postpartum treatment is still effective, and some patients showed self-healing with time during follow-up. The inflammatory response and coagulation function may affect the hearing of patients through a metabolic pathway.

Vertigo During Pregnancy: A Narrative Review of the Etiology, Pathophysiology, and Treatment

From the time of conception until the time of labor, a woman's body and mind undergo a variety of hormonal and other changes. Patients may also experience vertigo and a lack of balance during this period. Disabling and physically painful, these symptoms may strike at any moment. Pregnancy-related vertigo has been the focus of several studies. We looked at the research on vertigo in pregnant women in detail. This narrative review aims to examine the causes, pathophysiology, and current treatments for vertigo during pregnancy. Vertigo during pregnancy has a diverse etiology, with typical causes including hormonal changes and modifications in vascular dynamics. Vertigo may start to appear due to pathophysiological mechanisms involving vestibular and central nervous system adaptations. Numerous alternatives for treatment are available, including dietary changes, vestibular therapy, medicines, and surgical procedures. The thorough assessment of the current research on vertigo during pregnancy provided by this narrative review will help medical practitioners make wise clinical decisions.

Temporal Bone High Resolution Computed Tomography Findings in a Case of Postpartum Otosclerosis

We describe temporal bone high resolution computed tomography (HRCT) findings in a case of bilateral mixed fenestral and retrofenestral otosclerosis with onset in the postpartum period. This condition should be considered in women complaining of postpartum hearing loss and temporal bone HRCT is a fundamental tool leading to the diagnosis.

Otolaryngology and the Pregnant Patient

Importance

Pregnancy may result in physiologic and pathologic changes in the head and neck. Otolaryngologists may need to intervene medically or surgically with pregnant patients. Careful consideration of risks to both the gravid patient and the developing fetus is vital.

Observations

Patients may present with otolaryngologic complaints exacerbated by or simply occurring during their pregnancy. Symptoms of hearing loss, vertigo, rhinitis or rhinosinusitis, epistaxis, obstructive sleep apnea, sialorrhea, voice changes, reflux, subglottic stenosis, and benign and malignant tumors of the head and neck may prompt evaluation. While conservative measures are often best, there are medications that are safe for use during pregnancy. When required, surgery for the gravid patient requires a multidisciplinary approach.

Conclusions and Relevance

Otolaryngologic manifestations in pregnant patients may be managed safely with conservative treatment, medication, and surgery when necessary. Treatment should include consideration of both the pregnant patient and the developing fetus.

Treating Vestibular Migraine When Pregnant and Postpartum: Progress, Challenges and Innovations

Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.

Unexpected Motherhood-Triggered Hearing Loss in the Two-Pore Channel (TPC) Mutant Mouse

Calcium signaling is crucial for many physiological processes and can mobilize intracellular calcium stores in response to environmental sensory stimuli. The endolysosomal two-pore channel (TPC), regulated by the second messenger nicotinic acid adenine dinucleotide phosphate (NAADP), is one of the key components in calcium signaling. However, its role in neuronal physiology remains largely unknown. Here, we investigated to what extent the acoustic thresholds differed between the WT mice and the TPC KO mice. We determined the thresholds based on the auditory brainstem responses (ABRs) at five frequencies (between 4 and 32 kHz) and found no threshold difference between the WT and KO in virgin female mice. Surprisingly, in lactating mothers (at P9–P10), the thresholds were higher from 8 to 32 kHz in the TPC KO mice compared to the WT mice. This result indicates that in the TPC KO mice, physiological events occurring during parturition altered the detection of sounds already at the brainstem level, or even earlier.