Management of vertigo in pregnancy

Abstract

Background. Pregnancy is a specific female physiological period characterized by significant changes, included otological and neurotological manifestations. Vestibular disorders like vertigo and dizziness, are common complaints from pregnant women to primary care. Objectives. The aim of this paper is to describe clinical pictures, evaluation methods and therapeutic options of acute vertigo in pregnancy with the related pathogenetic hypotheses. Method. We describe 11 cases of vertigo in pregnancy. All patients underwent audio-vestibular evaluation, consisting of pure-tone audiometry, impedance and clinical testing of the vestibular function, the "bed side examination". Results. Audiological evaluation showed normal puretone audiometry and impedance in 10 patients. Only in one case a sudden right total deafness was highlighted with vestibular areflexia, showing a secondary positional vertigo. Seven patients presented a benign paroxysmal positional vertigo (BPPV) effectively treated by liberatory maneuvers. Three patients had a diagnosis of vestibular neuritis and they were treated with corticosteroids therapy with a complete resolution of dizziness and vertigo in one month. Conclusions. Our results point out the importance of multidisciplinarity between otolaryngologist, neurologist and gynecologist. From a pathogenic point of view, the vascular etiology, strictly related to the gravidic hormonal variations, is often hypothesized. SOMMARIORazionale. La gravidanza costituisce un periodo di vita per la donna, caratterizzato da significativi cambiamenti di tipo fisiologico e adattativo, incluse possibili manifestazioni otoneurologiche. Disturbi vestibolari quali vertigini e instabilità, costituiscono una sintomatologia frequente nelle donne in gravidanza. Obiettivo. Scopo dell'articolo consiste nel descrivere specifici quadri clinici, metodi diagnostici e opzioni terapeutiche di vertigine acuta in gravidanza con relative ipotesi patogenetiche. Materiali e metodi. Descriviamo 11 casi di vertigine in gravidanza. Tutte le pazienti sono state sottoposte ad esame cocleovestibolare, ossia ad esame audiometrico tonale, esame impedenzometrico e esame vestibolare, clinico, la cosiddetta "bed side examination". Risultati. All'esame audiompedenzometrico, 10 pazienti risultavano normoacusiche. Solo in un caso è stata riscontrata un'anacusia destra improvvisa associata ad areflessia vestibolare e successiva vertigine posizionale. Sette pazienti hanno presentato una vertigine parossistica posizionale benigna (BPPV) trattata con le manovre liberatorie. A tre pazienti è stata diagnosticata una neurite vestibolare, trattata con terapia corticosteroidea e conseguente completa risoluzione della sintomatologia in un mese. Conclusioni. Alla luce dei risultati ottenuti, si dimostra fondamentale la multidisciplinarietà tra otorinolaringoiatra, neurologo e ginecologo. Da un punto di vista patogenetico, l'eziologia vascolare, strettamente correlata alle variazioni ormonali durante la gravidanza, è spesso ipotizzata.

Association of Vertigo and Nausea and Vomiting of Pregnancy

“…These disorders affect the life routine involving family, social and professional environment thus causing deterioration of physical and psychological well-being. 2 The hormonal changes which occur during the menstrual cycle, gestation and menopause can cause changes in the homeostasis of labyrinthine fluids, as they have a direct effect on the enzymatic process and the action of neurotransmitters. These changes can be asymptomatic or present clinically as vestibular symptoms.…”

“…However, during gestation, these same symptoms could be secondary to non-vestibular causes but they could be a consequence of hormonal, anatomical and physiological factors affecting the musculoskeletal system occurring in pregnancy. 2 More than 50% of pregnant women experience dizziness or vertigo frequently in the first two gestational trimesters. 4 Vertigo is a sudden feeling of spinning.…”