Minas N. Artopoulos
Otorhinolaryngologist, Head & Neck Surgeon
Director of Neck-Thyroid Division at the MITERA Otorhinolaryngology Head & Neck Surgery Department

The pregnant woman holds a special place in Medical Science. Metabolic and endocrinological changes related to pregnancy can significantly affect head and neck.

Nasal congestion in pregnancy or pregnancy rhinitis is a rather common discomfort associated with pregnancy known for many years. In fact, it is believed that between 5% and 32% of all pregnant women will suffer from pregnancy rhinitis to some degree. It commonly occurs in the first trimester and in some cases it lasts till labor. Rhinitis of pregnancy is caused by the increase in the hormone estrogen during pregnancy since higher levels of estrogen swell the mucous membranes inside the nose. Rhinitis of pregnancy is accompanied by a runny nose and swollen mucosa that cause blockages of the sinuses resulting to sinusitis.
Worsening of hearing loss that is attributed to otosclerosis was first reported by Erhard in 1858. Before using stapedectomy for treatment, young women suffering from otosclerosis were advised to avoid pregnancy. According to various studies hearing loss in pregnancy is worsening from 25 to 45%. It is also evident that this condition is even worse for unoperated ears than operated. The best approach to the issue is surgical treatment before pregnancy and close monitoring of hearing during pregnancy as well after birth.

Nose bleeding in pregnancy is a common discomfort and can be attributed to various reasons. The nose is full of blood vessels. As the blood vessels in the body expand and the volume of blood pumping through the body expands it is very easy to have nose bleeds. This generalised increase on the vascular tissue leads also to the development of various disorders such as granulomas in the upper and lower jaw, nasal haemangioma, etc. These vascular formations typically appear on the oral and nasal cavities during the first months of pregnancy and disappear after labour or pregnancy termination.

Eustachian tube dysfunction is a discomfort affecting 5% to 30% of pregnant women and its symptoms are various. The dysfunction can be related to a closed Eustachian tube or a chronically open one. Symptoms usually appear after the first trimester of pregnancy. Women suffering from a closed Eustachian tube have a full ear and various sounds can be heard when air enters the middle ear. The cause of a closed Eustachian tube is swollen mucosa and body water retention. In severe cases, otitis media with effusion can also appear. Remedies include the use of a humidifier and performing of Valsalva maneuver several times a day.

Gastroesophageal reflux (GERD) appears in 30 to 50% of mothers-to-be and it is most common during the third trimester. GERD is caused by two different mechanisms. The increased abdominal pressure from the growing fetus causes heartburn. However, GERD can also have some uncommon symptoms such as Croup, which is swelling around the vocal cords, and Pharyngitis (sore throat) due to irritated mucus membranes from gastric fluids. Treatment is lifestyle modifications (diet, avoid eating 2-3 hrs before bedtime, elevated head of the bed, etc.) as well as limited use of over the counter acid-blocking medicines
About 10 to 15% of the pregnant women suffer from otitis externa during pregnancy. For symptoms relief it is best to use ear solutions, however, these do not treat the infection. In severe cases it is advisable to use steroid ear drops that treat infections and swelling.

The pregnant woman is a very special patient. She is frightened, stressed, exaggerates risks and is particularly skeptical to treatment. She also is accompanied by a stressed husband. Both of them need reassurance and a calm approach. Talking about the physiology of pregnancy and the mechanism that causes the various symptoms as well as about the fact that there are no impacts on the fetus should definitely comfort them.

Blood tests do not particularly help in the investigation of any infections due to maternal leukocytosis. It would be of particular interest to have results of blood tests conducted before pregnancy in order to be able to estimate, for example, blood loss during nose bleeds taking into account the existing iron deficiency anemia due to the pregnancy.