|Year : 2016 | Volume
| Issue : 2 | Page : 119-124
Otorhinolaryngological health of women attending antenatal care clinic in a tertiary hospital: The Aminu Kano Teaching Hospital experience
Abdurrazak Ajiya1, Rabiu Ayyuba2, Abdullahi Hamisu1, Sulaiman Muhammad Daneji3
1 Department of Otorhinolaryngology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||1-Aug-2016|
Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, P.M.B. 3011, Kano
Source of Support: None, Conflict of Interest: None
Background: Physiological changes of pregnancy have a profound effect on the head and neck region; pregnant women often present with otorhinolaryngological health challenges to the obstetricians. Objective: The objective of this study is to find out the otorhinolaryngological health complaints of pregnant women at Aminu Kano Teaching Hospital (AKTH). Materials and Methods: It was a cross-sectional study conducted among consenting pregnant women at AKTH. Ethical approval was obtained from the hospital ethical committee. The questionnaire was administered among consenting pregnant women. Data obtained were analysed using the Statistical Packages for Social Sciences version 18. Qualitative data were summarised using frequencies and percentages. Fischer's exact test was used for categorical data, and the P ≤ 0.05 was considered statistically significant. Results: A total of 146 pregnant women were recruited during the study. The mean age ± standard deviation was 28.57 years ± 5.796. Only 4 (2.7%) of the pregnant women were in the first trimester, while the rest were in second 47 (32.2%) and third trimester 95 (65.1%) respectively. Furthermore, few pregnant women 10 (6.8%) presented with mild hypertension, while in 136 (93.2%) of the pregnant women, the blood pressure measurements were normal. Ear itching 35 (24.0%), headache 42 (28.8%) and heartburn 55 (37.7%) were the most frequent complaints. High blood pressure was found to be statistically associated with tinnitus (P = 0.035), and high parity was also found to be associated with aural fullness (P = 0.028). Conclusion: The common otorhinolaryngological manifestations among pregnant women in this study were otomycosis, rhinitis and gastroesophageal reflux disease.
Keywords: Kano, otorhinolaryngological complaints, pregnant women
|How to cite this article:|
Ajiya A, Ayyuba R, Hamisu A, Daneji SM. Otorhinolaryngological health of women attending antenatal care clinic in a tertiary hospital: The Aminu Kano Teaching Hospital experience. Niger J Basic Clin Sci 2016;13:119-24
|How to cite this URL:|
Ajiya A, Ayyuba R, Hamisu A, Daneji SM. Otorhinolaryngological health of women attending antenatal care clinic in a tertiary hospital: The Aminu Kano Teaching Hospital experience. Niger J Basic Clin Sci [serial online] 2016 [cited 2022 May 20];13:119-24. Available from: https://www.njbcs.net/text.asp?2016/13/2/119/187358
| Introduction|| |
Pregnancy initiates a unique set of physiological and hormonal changes, which manifest effects on virtually every system in the woman's body. The head and neck region do not constitute an exception. These changes are commonly manifested as complaints concerning the head and neck.
Metabolic and physiologic changes during pregnancy result in increased cardiac output and expansion of blood volume. This causes boggy mucus membranes. Oestrogen and progesterone peak during the third trimester causing changes in mucosal lining, especially nasal, oral, pharyngeal and laryngeal membranes. There is also a rise in serum cortisol causing relative gestational immunosuppression, which leads to reactivation of latent viral infections.
Conditions of the ear that manifest in pregnancy include Eustachian tube More Details dysfunction (ETD), otosclerosis and sudden hearing loss. Pregnancy also flares up vertiginous spells in women with Meniere's disease. Bell's palsy and tinnitus occur more frequently during the third trimester of pregnancy.
Nasal diseases that are not uncommon in pregnancy comprise rhinitis, allergic rhinitis and nasal haemangioma. Oral and throat conditions commonly encountered in pregnancy include obstructive sleep apnoea, gastroesophageal reflux, granuloma gravidarum, laryngopathia gravidarum and ptyalism gravidarum. Gastroesophageal reflux is seen in 30–80% of pregnant women, whereas granuloma gravidarum in up to 5%.
Pregnant women commonly present with these complaints to the obstetrician, family physician or otorhinolaryngologist. While it is appreciated that many of these complaints are transient, their impact on the maternal quality of life can be significant. It, therefore, becomes important for medical practitioners to be familiar with these complaints for optimal reassurance, expectant management or treatment of the pregnant women.
There are no studies to our knowledge in Nigeria on the subject matter. The aim of this study was to find out the common ear, nose and throat complaints and the pattern of their distribution during pregnancy.
| Materials and Methods|| |
It was a cross-sectional study among consenting pregnant women at Aminu Kano Teaching Hospital (AKTH) within the study period which was from 1st November 2015 to 29th February 2016. Ethical approval was obtained from the hospital ethical committee. The questionnaire was structured, and pre-tested comprising close and opened ended questions. Administration of the questionnaire was by a trained research assistant on the consecutive pregnant women attending antenatal care at the antenatal clinic of AKTH. Informed consent was obtained from the participants before recruitment. Patients were recruited based on their willingness to participate in the study. Pregnant women below the age of 18 years were excluded from the study (difficulty obtaining assent).
Data obtained were analysed using the Statistical Packages for Social Sciences version 18 (SPSS Inc, Chicago, IL, USA). Qualitative data were summarised using frequencies and percentages. Fischer's exact test was used for categorical data, and the P ≤ 0.05 was considered statistically significant.
| Results|| |
A total of 146 pregnant women were recruited during the study (1st November 2015 to 29th February 2016). The mean age ± standard deviation (SD) was 28.57 years ± 5.796. The age range was from 19 years to 41 years. The median age was 28 years. Most of the respondent pregnant women were within the age group of 25–29 (31.5%) while the least were from the age group of 40–44 (3.4%) [Table 1].
The mean parity ± SD was 2.62 ± 2.658. The range was from 0 to 10 [Table 1]. A whopping figure of 74 (50.7%) were multipara while primigravida were 38 (26.0%). The mean ± SD of living children was 2.25 ± 2.374. The range was from 0 to 10.
Hausas were the major ethnic group 116 (79.5%) followed by the Igbos 12 (8.2%). Other minority group constituted 10 (6.8%) [Table 1].
All the respondent pregnant women were married 146 (100.0%).
Majority of the respondents 129 (88.4%) were of the Islamic faith. Christianity constituted 17 (11.6%).
As much as 70 (47.9%) attended and completed tertiary level of education followed by secondary 56 (38.4%) as their highest educational level. The least number of the respondents 8 (5.5%) had primary level as their highest educational qualification.
Most of the respondents 86 (58.9%) were home managers (house wives); the professional/executive constituted 16 (11.0%) [Table 1].
[Figure 1] and [Figure 2] depict the trimester of pregnancy and the blood pressure measurement of the respondents respectively. Only 4 (2.7%) of the pregnant women were in the first trimester, while the rest were in second 47 (32.2%) and third trimester 95 (65.1%), respectively. In addition, few pregnant women 10 (6.8%) presented with mild hypertension, while in 136 (93.2%) of the pregnant women, the blood pressure measurements were normal.
[Table 2] shows the ear complaints reported by the pregnant women. Ear itching 35 (24.0%) was the most reported complaint. There was no complaint of facial weakness.
There was no statistically significant association between pregnant women with elevated blood pressure and hearing loss (P = 0.807), vertigo (P = 0.648), aural fullness (P = 0.648), otalgia (P = 0.7510), ear discharge (P = 0.879) and autophony (P = 0.751). However, high blood pressure was found to be statistically associated with tinnitus (P = 0.035) and high parity was also found to be associated with aural fullness (P = 0.028). There was no statistically significant association between trimesters of pregnancy and ear complaints (hearing loss [P = 0.587], vertigo [P = 0.491], aural fullness [P = 0.169], tinnitus [P = 0.716], otalgia [P = 0.700], ear discharge [P = 1.000], ear itching [P = 0.281] autophony [P = 0.643]).
[Table 3] depicts nasal symptoms reported by the pregnant women. Headache 42 (28.8%) nasal discharge 36 (24.7%) and nasal congestion 30 (20.5%) were the most reported complaints. Facial pain 0 (0.0%) and anosmia 1 (0.70%) were the least reported complaints.
Oral and throat complaints were also shown on [Table 4]. Heartburn 55 (37.7%) and excessive salivation 16 (11.0%) were the most frequent complaints reported by the pregnant women. Nocturnal aspiration 1 (0.7%) was the least reported complaint.
Similarly, there was no any association between nasal symptoms, oral or throat complaints with any of high blood pressure, trimester of pregnancy or parity.
| Discussion|| |
Physiological, hormonal and immune status changes characteristic of pregnancy, impact changes in the upper respiratory tract mucosa with resultant expression of symptoms in pregnant women. This study just like several other previous reports ,, showed the occurrence of symptoms in pregnant women that depicts certain head and neck diseases or exacerbation of pre-existing ones.
Existing data suggest that ear problems may be increased in pregnancy. Ear itching featured prominently among the complaints by pregnant women in this study. This could be explained by increased chances of contracting otomycosis as a result of pregnancy-induced immune compromise. Other ear symptoms that were common among the women include vertigo, aural fullness, tinnitus, otalgia and autophony. These symptoms might be due to ETD or Meniere's disease. Tinnitus as a common symptom in pregnancy had being reported severally by other studies., For some, tinnitus will be a distressing experience and for others may indicate more serious conditions such as pre-eclampsia. ETD may either be due to increasing mucosal oedema resulting into an obstruction or become patulous where there is inadequate weight gain. In both cases, otitis media with effusion could arise. However, it usually resolves after delivery., Meniere's disease may be seen due to fluid retention with resultant decreased serum osmolality  and its symptoms could be worsened probably by oestrogen and progesterone.
Allergic rhinitis and rhinitis of pregnancy have been stated by several authors as the most common nasal diseases in pregnancy.,,, These diseases have recently been associated with snoring and obstructive sleep apnoea syndrome (OSAS) in pregnancy. The suggestive nasal symptoms: itchy nose, nasal congestion, excessive sneezing, rhinorrhoea together with snoring and OSAS were prominent nasal symptoms among the participants in this study. The secondary symptoms of snoring and OSAS with poor quality of sleep following nasal obstruction may result in gestational hypertension, preeclampsia and intrauterine growth retardation with lower Apgar scores in neonates., Obstructive sleep apnoea may be a result of a combination of factors, involving weight gain during pregnancy.
These consequences may similarly occur as a result of the oral breathing that follows nasal obstruction, as this may lead to decrease in inhalation of nitric oxide (NO) produced mainly in the maxillary sinuses to the lungs. NO decreases vascular resistance in addition to improving local oxygenation.,,
In this study, up to 7.5% of our respondents reported atopy. A study comparing birth weight between atopic and non-atopic pregnant women suggested that atopy, by favouring a T helper type 2 pattern of immune response, would lead to better pregnancy outcomes.,
The majority of our respondents reported heartburn as complaints, similar to findings in other studies., Together with heartburn, pregnant women in this study also frequently reported sore throat and hoarseness of voice. The triad of these symptoms could suggest gastroesophageal reflux, which is seen in 50–75% of pregnant women. The aetiology of gastroesophageal reflux in pregnancy is multifactorial. Reduced lower basal gastroesophageal sphincter pressure, increased intragastric pressure, delayed intestinal transit time and duodenogastric reflux have been found in pregnant women with heartburn, all factors which dispose to increased gastrooesophageal reflux.,
Hoarseness and loss of voice signify changes in voice, which is extremely sensitive to the endocrinologic changes of pregnancy resulting into alterations in fluid content of the lamina propria just beneath the laryngeal mucosa. Abdominal distension during pregnancy also interferes with abdominal muscle function, altering the mechanics of phonation and creating overuse injuries. These voice changes are called laryngopathia gravidarum, often associated with pre-eclampsia.,
Another prominent symptom reported by our respondents is excessive salivation variously referred to as ptyalism gravidarum, which is of unknown origin. These patients might have difficulty in swallowing saliva throughout all trimesters of pregnancy and may cause nocturnal wakening. Some researchers consider that ptyalism gravidarum has a physiological not psychological origin.
Sore throat, in addition to been a feature of gastrooesophageal reflux, could also be a feature of throat infection. Prior studies have suggested that pregnant women, as a result of modulations in the immune system, are more susceptible to upper respiratory tract infections., A study published in 2014, showed that pregnant women act as a reservoir for spreading potentially immunogenic (Groups C and G) and disease-producing (Group F) virulent strains of streptococci. Another recent case report showed that maternal infection by respiratory syncytial virus (RSV) is common in pregnancy, but the effect of maternal RSV infection on maternal and neonatal outcomes is under recognised.
| Conclusion|| |
The common otorhinolaryngological symptoms reported in this study revealed prominence of features of possible otomycosis, rhinitis and gastroesophageal reflux disease. Associations were also documented between tinnitus and aural fullness with mild hypertension and high parity respectively.
Recall bias of clinical symptoms by the participants and it being a questionnaire based study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar R, Hayhurst KL, Robson AK. Ear, nose, and throat manifestations during pregnancy. Otolaryngol Head Neck Surg 2011;145:188-98.
Shiny Sherlie V, Varghese A. ENT changes of pregnancy and its management. Indian J Otolaryngol Head Neck Surg 2014;66 Suppl 1:6-9.
Uchide K, Suzuki N, Takiguchi T, Terada S, Inoue M. The possible effect of pregnancy on Ménière's disease. ORL J Otorhinolaryngol Relat Spec 1997;59:292-5.
Shapiro JL, Yudin MH, Ray JG. Bell's palsy and tinnitus during pregnancy: Predictors of pre-eclampsia? Three cases and a detailed review of the literature. Acta Otolaryngol 1999;119:647-51.
Sills ES, Zegarelli DJ, Hoschander MM, Strider WE. Clinical diagnosis and management of hormonally responsive oral pregnancy tumor (pyogenic granuloma). J Reprod Med 1996;41:467-70.
Richter JE. Gastroesophageal reflux disease during pregnancy. Gastroenterol Clin North Am 2003;32:235-61.
Tsunoda K, Takahashi S, Takanosawa M, Shimoji Y. The influence of pregnancy on sensation of ear problems – Ear problems associated with healthy pregnancy. J Laryngol Otol 1999;113:318-20.
Anwar K, Gohar MS. Otomycosis; clinical features, predisposing factors and treatment implications. Pak J Med Sci 2014;30:564-7.
Gurr P, Owen G, Reid A, Canter R. Tinnitus in pregnancy. Clin Otolaryngol Allied Sci 1993;18:294-7.
Smith S, Hoare D. Ringing in my ears: Tinnitus in pregnancy. Pract Midwife 2012;15:20-3.
Weissman A, Nir D, Shenhav R, Zimmer EZ, Joachims ZH, Danino J. Eustachian tube function during pregnancy. Clin Otolaryngol Allied Sci 1993;18:212-4.
Derkay CS. Eustachian tube and nasal function during pregnancy: A prospective study. Otolaryngol Head Neck Surg 1988;99:558-66.
Demoly P, Piette V, Daures JP. Treatment of allergic rhinitis during pregnancy. Drugs 2003;63:1813-20.
Adeyemi AS, Akinboro AO, Adebayo PB, Tanimowo MO, Ayodele OE. The prevalence, risk factors and changes in symptoms of self reported asthma, rhinitis and eczema among pregnant women in Ogbomosho, Nigeria. J Clin Diagn Res 2015;9:OC01-7.
Namazy JA, Schatz M. Diagnosing rhinitis during pregnancy. Curr Allergy Asthma Rep 2014;14:458.
Ellegård E, Hellgren M, Torén K, Karlsson G. The incidence of pregnancy rhinitis. Gynecol Obstet Invest 2000;49:98-101.
Ellegård EK. Pregnancy rhinitis. Immunol Allergy Clin North Am 2006;26:119-35.
Franklin KA, Holmgren PA, Jönsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000;117:137-41.
Orban N, Maughan E, Bleach N. Pregnancy-induced rhinitis. Rhinology 2013;51:111-9.
Trønnes H, Wilcox AJ, Markestad T, Tollånes MC, Lie RT, Moster D. Associations of maternal atopic diseases with adverse pregnancy outcomes: A national cohort study. Paediatr Perinat Epidemiol 2014;28:489-97.
Savilahti E, Siltanen M, Pekkanen J, Kajosaari M. Mothers of very low birth weight infants have less atopy than mothers of full-term infants. Clin Exp Allergy 2004;34:1851-4.
Okholm M, Jensen SM. Gatroesophageal reflux in pregnant women. Ugeskr Laeger 1995;157:1835-8.
Gill SK, Maltepe C, Koren G. The effect of heartburn and acid reflux on the severity of nausea and vomiting of pregnancy. Can J Gastroenterol 2009;23:270-2.
Brodnitz FS. Hormones and the human voice. Bull N
Y Acad Med 1971;47:183-91.
Höing R, Seitzer D. Clinical aspects of laryngopathia gravidarum. Laryngol Rhinol Otol (Stuttg) 1988;67:564-6.
Van Dinter MC. Ptyalism in pregnant women. J Obstet Gynecol Neonatal Nurs 1991;20:206-9.
Harris J, Sheiner E. Does an upper respiratory tract infection during pregnancy affect perinatal outcome? A literature review. Curr Inf Dis Rep 2013;15:143-7.
Longman RE, Johnson TR. Viral respiratory disease in pregnancy. Curr Opin Obstet Gynecol 2007;19:120-5.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]