Otosclerosis may lead to hearing loss
The primary disease of the otic capsule, otosclerosis is characterized by alternating phases of absorption of compact bony tissue and replacement with spongy bone. The most common location of this disorder is the oval window, and it can lead to stapedial ankylosis and subsequent conductive hearing loss. The disease can eventually progress to cochlear otosclerosis with sensorineural hearing loss.
Otosclerosis is multifactorial in origin, with contributors that include genetics, fluoridated water, exposure to measles, and vitamin D deficiency.
Pregnancy probably does not accelerate otosclerosis
Early reports, based on subjective, self-reported hearing endpoints, suggested that pregnancy might cause or accelerate the process of otosclerosis.20 In the 1950s, some authors even advocated termination of pregnancy and sterilization as treatment in progressive cases.21 The likely source of this idea was a paper written by Greifenstein in 1939, which stated the official policy of the German Reichsgutacherstelle (Agency of Expert Opinion of the German Reich) in regard to abortion and sterilization in women who had genetic disease.22 As a result of this guideline, in 1939, of 69 women who had otosclerosis in Germany, 43 underwent abortion and 23 were sterilized.23
Recent research argues strongly against an association between pregnancy and accelerated otosclerosis. Rigorous audiometry found no adverse effect on hearing in otosclerotic women who had children, compared with women without children. Nor were air conduction, bone conduction, and discrimination worse in women who had children, compared with childless women. No significant correlation was found between the number of children and hearing loss, or between lactation and hearing loss.24
Treatment of otosclerosis entails amplification throughout the pregnancy. Postpartum, an elective stapedectomy, in which the sclerotic stapes bone is replaced with a micro-prosthesis, frequently provides a clinically significant increase in hearing.
Sudden sensorineural hearing loss is rare
Although it is uncommon during pregnancy, sudden sensorineural hearing loss has been associated with hypertension and toxemia of pregnancy, presumably due to microemboli-mediated vascular occlusion of the microcirculation of the cochlea and auditory nerve. Complete otologic and audiologic evaluation, as well as treatment of the toxemia, is the standard of care.
Melasma affects almost 75% of gravidas
The “mask of pregnancy” is one of the most frequently encountered changes of pregnancy. The condition is thought to be driven by sun exposure and concomitant increases in the levels of melanocyte-stimulating hormone, serum estrogen, and progesterone. Well-delineated areas of hypermelanosis affect the face and neck. These lesions can begin during pregnancy, or become worse if they were present before conception. The most frequently involved sites are the cheeks, nose, and chin.
Avoidance of sunlight is the treatment for melasma
Topical sunscreens are recommended. Melasma typically regresses after delivery but persists in fewer than 10% of cases. Persistent hyperpigmentation can be treated with a variety of topical agents, including hydroquinone, tretinoin, kojic acid, and vitamin C, among others.25 Treatment is not always effective, however. Extensive pigmentary changes predict a poor response to topical therapy.
Pyogenic granuloma usually regresses postpartum
Granuloma gravidarum, or pyogenic granuloma of pregnancy, consists of soft, pedunculated, vascular proliferations, most commonly arising from the gingiva and nasal mucosa in 2% of pregnant women.25 These proliferations are thought to be triggered by the myriad hormonal changes of pregnancy superimposed on local tissue trauma. These lesions rarely exceed 2 cm in size, but they can ulcerate and cause pain. They frequently regress 1 to 2 months postpartum. Surgical resection is utilized only to stanch recalcitrant bleeding. When lesions recur after surgical excision, inadequate resection is thought to be the cause. A recent report described the Nd:YAG laser as an effective tool for treatment of these lesions.26
Part 1 of this series focuses on sinonasal disease in pregnancy.
We want to hear from you! Tell us what you think.