The conditions or illness under the purview of ENT are common. Moreover, during pregnancy, a woman’s body goes through a lot of transformations. Take gastroesophageal reflux disease (GERD) for example. Experts estimate that a lot of people suffer from this condition, some speculate that one-third of the total population does. In pregnancy, endocrine and anatomic factors converge to exacerbate acid reflux disorders in 30% to 50% of women.
Pregnancy brings many hormonal and physiological changes, with the ear, nose, and throat (ENT) region being no exception. Almost 30% of women during their pregnancy suffer from nasal disorders, including increased chances of rhinitis and congestion of the sinuses. The same may lead to a higher rate of sinusitis as well as epistaxis. For various ENT problems, the incidence is generally similar to non-pregnancy. Let’s take a look at the changes in the ear, nose, and throat individually.
Otitis externa: OTC or home-based treatments are safe in pregnancy if there is no evidence of tympanic membrane perforation. If eardrum perforation is not accurately diagnosed, then hydrocortisone/ciprofloxacin otic suspension may be used, or less expensive option would be using ofloxacin otic suspension plus 0.05% dexamethasone ophthalmic suspensions.
Dizziness: Review blood pressure to ensure the symptoms are not a part of a pregnancy-induced hypertension problem. Also, evaluate neurologic status for any other signs of vertebrobasilar CVA. One prospective study found that 52% of a pregnant cohort complained of dizziness. Most cases are secondary to non-vestibular causes. Nausea and vomiting associated with pregnancy may be precipitated or influenced by the hormonal or fluid-volume changes occurring in the vestibular system. Treatments include anti-emetics, meclizine other repositioning maneuvers for the same indications as in non-pregnancy. When used for proper indications, the medicines are generally considered safe throughout pregnancy.
Tinnitus: Tinnitus may be an early warning sign of gestational hypertension and preeclampsia. Evaluate blood pressure accordingly. The only randomized control trial of allergic rhinitis in pregnancy failed to demonstrate a benefit of fluticasone compared to placebo in pregnant women.
Pregnancy rhinitis: Pregnancy rhinitis has been reported in nearly one-quarter of all pregnancies. It can manifest in any trimester with complete resolution noted within 2 weeks of delivery. The only randomized control trial of allergic rhinitis in pregnancy failed to demonstrate a benefit of fluticasone compared to placebo in pregnant women. Nasal lavage is an acceptable therapy for pregnancy-associated rhinitis. Although it is unknown whether or not pregnancy is associated with increased sensitivity to allergens, antihistamines can be used for symptom control.
Dizziness: Evaluate blood pressure and neuro status to r/o preeclamptic condition and/or CVA. For vestibular type problems treatment is similar to non-pregnancy; e.g. ondansetron, metoclopramide, meclizine, and repositioning.
Acute Bacterial Rhinosinusitis: Similar to non-pregnancy. Amoxicillin-clavulanate drug of choice with fluoroquinolones acceptable in high lactam and macrolide-resistance settings.
Epistaxis: Rates of epistaxis are increased in pregnancy up to 20% vs. 6% of non-pregnant women, likely secondary to increased vascularity of the nasal mucosa. Pregnant women may also develop gravid granulomas and nasal hemangiomas that lead to severe bleeding. With packing, use antibiotics as in non-pregnancy; beta-lactams are safe. Similar treatment as in non-pregnancy. In transnasal thrombin is category C – concern due to pregnancy are already hypercoagulability. Discuss with the expert consultant before us
Intranasal thrombin is category C: As pregnant patients are already hypercoagulable, the effect of the drug may be a concern. Discuss with the appropriate consultant before use.
Sore throat: Pharyngitis in pregnancy is secondary to GERD as a result of progesterone-induced decreased lower esophageal tone. Symptoms tend to dissipate postpartum, and treatment should begin conservatively. However, proton pump inhibitors and H2 antagonists are considered safe treatments by most specialists.
Hoarseness: It may be caused by changes in the fluid content of the lamina propria just beneath the laryngeal mucosa. Symptoms include hoarseness, voice loss, deeper voice, and diminished range of pitch. Treatment is supportive with hydration, and singers are encouraged to refrain from singing. Symptoms typically resolve postpartum.
Thyroid Nodules: Diffuse thyroid enlargement during pregnancy occurs in up to 50% of pregnant women. The growth of existing nodules and new nodule formation may also occur during pregnancy. Initial TSH may be helpful, but generally, these patients, if stable, are referred for outpatient workup.
Also Read: 10 Natural Remedies for Sore Throat
Final view at ENT changes
It must be quite clear to you that there are a lot of complications that may arise during a gestation period. Also, this is an indication of a greater need for an ENT specialist if you are pregnant. The ENT specialist is trained and qualified to manage & diagnose conditions in the ear, nose, and throat. Also, they are capable of performing advanced surgical procedures on an outpatient basis. The modern treatments are not only better and more precise but also offer faster recovery. That’s not all of it, they are painless, take only a couple of hours and cure the patients within 3-4 days.
If you are looking for an ENT specialist for a consultation or to discuss some symptoms that you may be facing, make an appointment as soon as possible.