Inner ear disorders in 68 pregnant women: a 20-year experience

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.

Objective Measurements of Nasal Obstruction and Eustachian Tube Function in Pregnant Women

Background: Hormonal changes during pregnancy have a substantial effect on the swelling of the mucous membrane in the nasal cavity, resulting in rhinitis and Eustachian tube dysfunction. The aim of the study was to assess subjective and objective changes in nasal cavity and Eustachian tube patency in the third trimester of pregnancy. Materials and Methods: The study group included fifty 18-41 year-old women in the third trimester of pregnancy. The control group consisted of 25 females aged 25 to 31 who were not pregnant. The Eustachian tube and nasal cavity patency examination was carried out using a rhinomanometer, a tympanometer and a SNOT-22 Questionnaire. Results: The SNOT-22 showed that subjective nasal obstruction was assessed as strong or worse by 42% of the study group, which was significantly higher than in the control group and confirmed with rhinomanometry. A total of 68% of the study group reported a subjective ear fullness which correlated with the week of pregnancy. The tympanometry showed that all pregnant women exhibited a type A tympanogram, but tympanometry values decreased at higher weeks of pregnancy, and statistical analysis confirmed a significant difference between the study group and the control group in tympanometry for both ears. Conclusions: The results highlight the substantial impact on both subjective and objective measurements of nasal and Eustachian tube patency. Almost every woman in the third trimester of pregnancy experiences nasal obstruction, and nearly 70% struggle with ear fullness. Recognizing and addressing these challenges are pivotal for ensuring the well-being of pregnant individuals and enhancing the quality of antenatal care.

Vestibular Findings on the Video Head Impulse Test (vHIT) in Pregnancy: A Cross-Sectional Study

Background Functional and anatomic changes occur during pregnancy. Some of these changes are in the auditory and vestibular systems. However, there is a lack of information about the functional changes to critical structures that contribute to balance and proprioception. This study aims to evaluate the functions and shifts to the semicircular canals throughout gestation. Methodology This is a cross-sectional study. A video head impulse test (vHIT) was performed on all healthy pregnant patients with gestational periods ranging from the 20th to 40th weeks who were admitted to a maternal-fetal care unit. Vestibulo-ocular reflex (VOR) gains in the lateral, posterior, and anterior semicircular canals and gains in asymmetry were obtained. Results A significant positive relationship was observed in the right (R = 0.1064; P = 0.0110) and left (R = 0.2993; P = 0.0001) lateral semicircular canals as gestational weeks increased. Lower gains were seen at the start of the second trimester for the lateral canals. No significant gains were seen in the anterior or posterior canals throughout pregnancies until labor. No significant gains in asymmetry were detected. Conclusions Pregnant females may present vestibular changes in the semicircular lateral canals starting from the 20th week of gestation until labor. Increased gains may be associated with volumetric changes probably given by hormonal actions.

A Systematic Review of Vertigo: Negligence in Pregnancy

From conception to childbirth, there are many physical, hormonal, and psychological changes that a woman undergoes during pregnancy. During this time, balance is also affected, resulting in symptoms like vertigo and unsteadiness. These symptoms can lead to physical impairment and disability and can develop at any time. Vertigo in pregnancy has not been extensively written about. The subject of a narrative review is vertigo in pregnant patients. In pregnant women, hormonal alterations in the peripheral tissues and inner ear organs may contribute to vertigo. Meniere's disease, mild convulsive positional dizziness, and oculomotor migraines are all commonly exacerbated by pregnancy. Between the second and third trimesters of pregnancy, specific modifications to proprioception and hearing are also detected during physical examination. Patients who are pregnant typically experience these symptoms throughout this time. Some vertigo conditions can worsen during pregnancy, while others can appear at any time. Understanding audio-vestibular symptoms' pathological and clinical relationship during pregnancy requires more study.

Vertigo in Pregnancy: A Narrative Review

During pregnancy, physical, hormonal, and psychological changes may occur from conception to labor. Balance is also impacted throughout this time, leading to symptoms such as vertigo and unsteadiness. These symptoms may appear at any time and can cause disability and physical impairment. Little has been published about vertigo in pregnancy. We performed a narrative review of vertigo in pregnant patients. Vertigo in pregnant females may be associated with hormonal changes in peripheral structures and inner ear organs. Meniere’s disease, vestibular migraine, and benign paroxysmal positional vertigo are usually exacerbated during pregnancy. Specific changes to hearing and proprioception in the physical examination are also noted between the second and third trimester of pregnancy. These symptoms are usually seen in pregnant patients throughout this time. Some types of vertigo may be exacerbated and others may present at any time of pregnancy. Further research is needed to understand the clinical and pathological association of audiovestibular symptoms during pregnancy.

Audio-vestibular disorders and pregnancy: A systematic review

PURPOSE

During pregnancy a woman's body undergoes many physiological changes that involve all systems and organs, including sensory ones. We conducted this systematic review to highlight current evidence and treatment options in pregnant women with audio-vestibular disorders.

MATERIALS AND METHODS

A search was made on the following databases: PubMed, PubMed Central, Web of Science and Scopus. This research protocol was deposited in the PROSPERO Database.

RESULTS

After application of inclusion-exclusion criteria, 30 manuscripts were included in the review. Many authors (14/15) found a slight alteration of audiometric tests during pregnancy, with a reported recovery postpartum in most of the studies (5/7). Regarding sudden sensorineural hearing loss (SSNHL), we found four articles for a total of 69 patients: the treatment of choice was intravenous Dextran 40 and intra-tympanic corticosteroids. Most included studies (4/6) found neither clinical nor epidemiological associations between otosclerosis and pregnancy in large-based sample studies. Few investigations regarded Eustachian tube function and vertigo.

CONCLUSIONS

According to our results, many variations of hearing acuity during pregnancy are slight and transient and require only clinical observation. In large samples, otosclerosis appeared not to be associated with pregnancy. Clinicians should consider intra-tympanic steroids in managing SSNHL during pregnancy. Further more accurate research is needed to deepen and clarify the association between pregnancy and audio-vestibular disorders.

Sudden sensorineural hearing loss during pregnancy: etiology, treatment, and outcome

OBJECTIVE

To analyze the etiologies, treatments, and outcomes of sensorineural hearing loss (SSNHL) during pregnancy.

STUDY DESIGN

Retrospective chart review of 25 pregnant patients treated for SSNHL between January 2012 and September 2019. Forty-nine age matched non-pregnant women with severe and profound hearing loss diagnosed with SSNHL during the same period served as controls. Data were recorded on age, symptoms, onset of hearing loss, audiometric results, treatments, and outcomes.

RESULTS

The mean age was 29.6 years (range 23-38 years). Intratympanic steroids (ITS) were administered in 15 (60.0%) pregnant women with SSNHL. Three women were treated with postauricular steroids only, while another woman was treated with intravenous ginkgo leaf extract and dipyridamole. The remaining six women received no medications. More than half (8/15, 53.3%) of pregnant women with SSNHL receiving ITS experienced hearing improvement. Pregnant women with profound hearing loss who received no medication had no hearing improvement. Most pregnant women with SSNHL (12/15, 80.0%) had higher fibrinogen levels than controls (mean values 3.77±0.71 g/L and 2.54±0.48 g/L, respectively).

CONCLUSION

Fibrinogen could be a risk factor for SSNHL during pregnancy. ITS may benefit pregnant women with severe and profound SSNHL.

Clinical management and progress in sudden sensorineural hearing loss during pregnancy

Sudden sensorineural hearing loss (SSNHL) is a relatively rare, but distressing, disease in pregnant women. Little is known about the causes, clinical manifestations, treatments, and prognosis of SSNHL. Some hypotheses have been proposed to explain the pathophysiological mechanism of SSNHL, but most of them have not been identified. This article reviews the existing literature to present a summary of this clinical problem. Most patients suffer from SSNHL in the second or third trimester, and show moderate to profound hearing loss. The interval between the initial treatment and onset of hearing loss is less than 10 days in most patients. Some patients with SSNHL show tinnitus, vertigo, or dizziness, and fullness of the ear. Although some patients have a tendency for self-cure, treatment with intravenous dextran 40 combined with intratympanic corticosteroids is probably a safe and effective therapeutic strategy for pregnant patients with SSNHL. Further clinical research is necessary to identify the best therapeutic strategy for these patients.