Pregnancy is associated with many hormonal and physiological changes, with the ear, nose and throat (ENT) region being no exception. Approximately 30% of gravid women suffer from nasal disorders, including increased incidence of rhinitis and congestion of the sinuses that may lead to a higher rate of sinus infections as well as an increased incidence of epistaxis.^1,2,3 For other ENT problems, the incidence is generally similar to non-pregnancy.⁴ (See Table 1 for a clinical tool covering key principles.)

‘Pharyngitis in pregnancy is often secondary to GERD as a result of progesterone-induced decreased lower esophageal tone. … Treatment should begin conservatively.’

Ears

Otitis externa: Usual treatments, including polymyxin B-neomycin-hydrocortisone otic suspension, are safe in pregnancy if there is no evidence of a tympanic membrane perforation. If tympanic membrane perforation cannot be safely ruled out, then hydrocortisone/ciprofloxacin otic suspension may be used, or the (usually) less expensive option would be using ofloxacin otic suspension plus 0.05% dexamethasone ophthalmic suspension.

Dizziness: Review blood pressure to make sure the symptom is not 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.⁵ The 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 (e.g., ondansetron, metoclopramide), meclizine, and canalith or 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.⁶

‘The only randomized control trial of allergic rhinitis in pregnancy failed to demonstrate a benefit of fluticasone compared to placebo in pregnant women.’

Nose

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.4 The only randomized control trial [RCT] of allergic rhinitis in pregnancy failed to demonstrate a benefit of fluticasone compared to placebo in pregnant women.⁷ Nasal lavage is an acceptable therapy for pregnancy-associated rhinitis.⁸ Although it is unknown whether or not pregnancy is associated with an increased sensitivity to allergens, antihistamines can be used for symptom control. First generation antihistamines (e.g., chlorpheniramine, tripelennamine) and second generation antihistamines (e.g., loratadine) are options.⁹