Audio-vestibular disorders and pregnancy: A systematic review

Vertigo During Pregnancy: A Narrative Review of the Etiology, Pathophysiology, and Treatment

From the time of conception until the time of labor, a woman's body and mind undergo a variety of hormonal and other changes. Patients may also experience vertigo and a lack of balance during this period. Disabling and physically painful, these symptoms may strike at any moment. Pregnancy-related vertigo has been the focus of several studies. We looked at the research on vertigo in pregnant women in detail. This narrative review aims to examine the causes, pathophysiology, and current treatments for vertigo during pregnancy. Vertigo during pregnancy has a diverse etiology, with typical causes including hormonal changes and modifications in vascular dynamics. Vertigo may start to appear due to pathophysiological mechanisms involving vestibular and central nervous system adaptations. Numerous alternatives for treatment are available, including dietary changes, vestibular therapy, medicines, and surgical procedures. The thorough assessment of the current research on vertigo during pregnancy provided by this narrative review will help medical practitioners make wise clinical decisions.

Temporal Bone High Resolution Computed Tomography Findings in a Case of Postpartum Otosclerosis

We describe temporal bone high resolution computed tomography (HRCT) findings in a case of bilateral mixed fenestral and retrofenestral otosclerosis with onset in the postpartum period. This condition should be considered in women complaining of postpartum hearing loss and temporal bone HRCT is a fundamental tool leading to the diagnosis.

Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy

All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.

Otolaryngology and the Pregnant Patient

Importance

Pregnancy may result in physiologic and pathologic changes in the head and neck. Otolaryngologists may need to intervene medically or surgically with pregnant patients. Careful consideration of risks to both the gravid patient and the developing fetus is vital.

Observations

Patients may present with otolaryngologic complaints exacerbated by or simply occurring during their pregnancy. Symptoms of hearing loss, vertigo, rhinitis or rhinosinusitis, epistaxis, obstructive sleep apnea, sialorrhea, voice changes, reflux, subglottic stenosis, and benign and malignant tumors of the head and neck may prompt evaluation. While conservative measures are often best, there are medications that are safe for use during pregnancy. When required, surgery for the gravid patient requires a multidisciplinary approach.

Conclusions and Relevance

Otolaryngologic manifestations in pregnant patients may be managed safely with conservative treatment, medication, and surgery when necessary. Treatment should include consideration of both the pregnant patient and the developing fetus.

Treating Vestibular Migraine When Pregnant and Postpartum: Progress, Challenges and Innovations

Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.

Unexpected Motherhood-Triggered Hearing Loss in the Two-Pore Channel (TPC) Mutant Mouse

Calcium signaling is crucial for many physiological processes and can mobilize intracellular calcium stores in response to environmental sensory stimuli. The endolysosomal two-pore channel (TPC), regulated by the second messenger nicotinic acid adenine dinucleotide phosphate (NAADP), is one of the key components in calcium signaling. However, its role in neuronal physiology remains largely unknown. Here, we investigated to what extent the acoustic thresholds differed between the WT mice and the TPC KO mice. We determined the thresholds based on the auditory brainstem responses (ABRs) at five frequencies (between 4 and 32 kHz) and found no threshold difference between the WT and KO in virgin female mice. Surprisingly, in lactating mothers (at P9–P10), the thresholds were higher from 8 to 32 kHz in the TPC KO mice compared to the WT mice. This result indicates that in the TPC KO mice, physiological events occurring during parturition altered the detection of sounds already at the brainstem level, or even earlier.