Ear pain in pregnancy

Ear pain during pregnancy can be caused by various reasons – and the main thing is to exclude an infectious process that threatens the mother and child. Do not panic right away if you have this symptom. You need to figure out the cause, and then start treatment.

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Causes earache in pregnancy

Any infectious disease in pregnant women is a problem. Since you cannot have full treatment and take all the necessary medications, while the harm from bacteria and viruses is significant, you should think in advance about preventing ENT diseases and other diseases during pregnancy. Unfortunately, not everyone manages to avoid such diseases. Ear infection is one of the most common pathologies that many women face during pregnancy.

Ear pain is one of the most intense types of pain. It can be sharp, stabbing pain or a dull ache that radiates to the head and sinuses. The pain can be felt in one or both ears, sometimes developing into a chronic condition and can be caused by an infection, a foreign object, or an insect that settles in the ear.

If you are prone to ear infections during pregnancy, you should be careful about them. There are a number of causes of ear pain during pregnancy. Ear pain can develop due to a fungal infection, earwax, or pressure created during rest.

An ear infection occurs when certain bacteria or a virus attacks the middle ear, located behind the eardrum. This causes fluid to build up and the middle ear to become inflamed, causing severe pain. Infections can be acute or chronic. Acute infections are painful but only last for a short period. Chronic infections recur and can cause permanent damage to the inner and middle ear. Many factors can cause ear infections.

Ear infections are caused by pathogens, such as bacteria or a virus, that enter the ear. The inflammation causes a blockage in the Eustachian tubes (the tube that connects the middle ear and the throat). This blockage causes fluid to accumulate in the middle ear, which leads to infection. In some cases, this can lead to temporary hearing loss.

If a woman has chronic ear infections, she will be at high risk of getting an ear infection during pregnancy.

The pathogenesis of the development of symptoms and the intensity of pain depends on the localization of the process. Otitis is an inflammation of the ear, which can have different forms depending on the localization of inflammatory changes. The ear consists of external, middle, and internal parts. The names of ear infections come from the names of the ear parts: external otitis, middle otitis, and internal otitis (labyrinthitis). External otitis is characterized by inflammation of the auditory canal, auricle, and eardrum. Otitis affects mainly the mucous membrane of the eardrum and auditory tube. The middle ear consists of mammillary cells and the temporal bone. If the disease spreads to this area, otitis is considered to be complicated by mastoiditis.

The most serious disease is labyrinthitis, or otitis media. The inner ear, in addition to the cochlea (sound analyzer), includes a vestibular receptor, so such otitis during pregnancy can provoke vestibular failures and affect hearing function. External otitis is considered the safest in terms of consequences, while most often pregnant women suffer from catarrhal otitis media and purulent otitis.

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Risk factors

Risk factors for ear pain during pregnancy include pregnancy itself, which reduces the ability of the female body to fight many bacteria and viruses. In most cases, otitis is caused by a pregnant woman's reduced immunity, as the body becomes more vulnerable to infections. As a result, the slightest cooling of the head or ear contributes to the development of the first symptoms of the disease, as bacteria begin to multiply in the outer and middle ear.

Viral infections can also contribute to the development of otitis during pregnancy. If you are prone to ear pathologies, you may experience unpleasant otitis due to ARVI. An outbreak of other chronic diseases such as sinusitis, tonsillitis, rhinitis can have the same effects, because all these organs are interconnected, and the infection can freely move from the nasopharynx, nose and throat to the ear through the auditory tube. If a woman has problems such as a deviated septum, hypertrophy of the nasal tonsils or polyps, somatic diseases, the risk of developing otitis during pregnancy will be even higher.

Ear pain can be caused by irritation from water, a condition called secondary otitis.

This is an infection that occurs in the canal between the outer ear and the eardrum. Although this infection can be caused in many ways, it is mostly caused when water enters the ears while swimming. It can also be due to an infected hair follicle in the ear or abrupt cleaning of the ear. A blocked ear canal can cause severe pain and a feeling of fullness in the ear.

Another common and simple cause of ear pain during pregnancy is earwax. Normally, the air pressure inside and outside the ear is the same. But many things can block the Eustachian tube, which connects the middle ear to the back of the nasal passage and throat. When this happens, the Eustachian tube is unable to maintain the correct, uniform air pressure. This causes ear pain. During pregnancy, under the influence of hormones, the synthesis of earwax can increase, so pregnant women are more likely to experience this problem. Usually, during air travel, at high altitudes or underwater, when there is constant outside air pressure, there is usually a pressure surge in the ears. This can also be a cause of ear pain.

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Epidemiology

Statistics on the prevalence of ear pain during pregnancy indicate a high frequency of this pathology. Every tenth pregnant woman can experience this feeling, and more than 78% of cases are an inflammatory process. Otitis, or ear infections, is one of the most common childhood diseases, but it affects adults less often, especially pregnant women, due to the peculiarities of the immune system. The frequency of complications is very low, but, nevertheless, the process itself can be very disturbing for the expectant mother.

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Symptoms

Symptoms of otitis in pregnant women may include more than just ear pain. Most pregnant women with otitis have the following symptoms:

• a feeling of pressure in one or both ears;
• noise in the head;
• itching, irritation in the ear canal;
• fluid leaking from the ear;
• hearing impairment;
• general malaise;
• increase in body temperature;
• lymphadenitis.

The first signs of inflammation in the ear may be an increase in body temperature, and only then may pain appear. This may indicate an infection.

There are different types of otitis by localization - external, internal and middle. Also, by the degree of the inflammatory process, catarrhal, purulent and gangrenous are distinguished. Such types of otitis can be considered stages of the process development, since if one type is not treated, it can develop into the next type of inflammation.

Typically, the initial stage of otitis media is characterized by sharp pain when turning the head or in a calm state. After a few days without adequate therapy, such otitis develops into a purulent form. The tympanic cavity, filled with purulent fluid, puts pressure on the eardrum, which finally collapses. After this, the pain decreases, and the ear canal is filled with pus, and sometimes blood. The perforation of the eardrum gradually heals, hearing improves or is completely restored.

But such symptoms may vary in pregnant women. Most often, otitis is suppressed at first, but sometimes it develops quickly, accompanied by malaise, but does not show any local symptoms. In some cases, a pregnant woman with ear tissue destruction may have a normal body temperature and feel well.

Ear pain during pregnancy in the 1st trimester is more often due to infection, since during this period the woman's immune system adapts to the child, and it is slightly weakened. When ear pain during pregnancy occurs in the 2nd and 3rd trimesters, it may be an ear plug. In this case, the woman may feel a blocked ear, a slight tingling sensation, and the pain is less intense than with otitis. It is also necessary to remember whether the pregnant woman has recently swum in a pool, which can also cause such a symptom.

Sometimes it happens that the ear is blown out during pregnancy. This is a popular concept, but it covers precisely those cases when otitis occurs at low ambient temperatures. Overcooling outside can change the pressure in the ear, and this in turn disrupts the air flow, which can be a risk factor for stagnation of bacteria in the ear. This is how otitis develops.

The consequences and complications of the disease on the fetus are clear: all viral infections have negative consequences, while some of them are able to penetrate the placental barrier, preventing normal development, and cause hypoxia. Infectious diseases can provoke a miscarriage, premature birth and cause other problems. Fortunately, if a pregnant woman consults a doctor in the early stages, the disease will not spread to other organs and will not cause any complications, since it will stop locally. Otitis can harm both the child and the expectant mother. Without adequate therapy, it often becomes chronic, and regular outbreaks lead to hearing loss.

Diagnostics earache in pregnancy

Diagnosis of otitis media in pregnant women includes otoscopy, microbiological examination of the ear smear. If necessary, the woman is prescribed hearing tests (camera test or audiometry), testing the function of the auditory tubes, endoscopic examination of the nasopharynx. Radiography and CT in pregnant women are strictly prohibited, and if urgently needed, a woman can be prescribed MRI, starting from the second trimester of pregnancy. A simple anamnesis can suggest a diagnosis. But to determine the involvement of otitis media and visualization, it is necessary to examine the tympanic membrane, which is necessary for making a diagnosis. This is usually done with a pneumatic otoscope attached to a rubber bulb, which helps to view the eardrum and assess its mobility.

Otoscopy is a test that involves examining the ear with an instrument called an otoscope (or auriscope). This is done to examine the external auditory canal, the tunnel that leads from the outer ear to the eardrum.

Examining the eardrum can also provide a lot of information about what's going on in the middle ear, the space inside the skull where the hearing and balance mechanisms are located.

Before the otoscope cone is inserted into the ear canal, the outer ear is checked for signs of disease that may be related to the patient's symptoms. This can rule out wax, which can also cause ear pain in pregnant women. Examination of the outer ear canal is done by gently pulling the outer part of the ear up and back. This action straightens the outer ear canal, which has a natural curve and makes it easier to see the eardrum.

The normal external auditory canal has some hair, often lined with yellow-brown wax. The total length of the ear canal in adults is approximately 2 cm.

A normal eardrum is pinkish-gray in color and roughly round in shape. Most otoscopes have a small connection to a vent that allows the doctor to blow air into the canal. By watching how much the eardrum moves with the air pressure, its mobility is assessed, which is dependent on the pressure inside the middle ear. This technique is called insufflation. Normally, the air pressure in the middle ear is the same as that in the outer ear. This allows the eardrum to lie in a mid-position and respond most effectively to sound vibration. When the Eustachian tube is blocked, the eardrum remains motionless.

The changes in the eardrum in acute otitis media depend on the time of infection. Typically, the eardrum becomes red or yellow in appearance and is opaque with unclear landmarks – it may appear convex. Insufflation may show decreased mobility.

Sometimes in acute otitis media the eardrum will rupture, allowing the pressure (and pain) to be relieved. Mucus can then often be seen, as well as discharge in the outer ear.

Signs of otitis media on visual inspection of the membrane include: fullness, cloudiness, redness (erythema). It can sometimes be difficult to confirm the diagnosis with a visual inspection of the eardrum. This can happen because the ear canal is very small, making it difficult to get a clear view. Earwax may also obstruct the view through the ear canal, and if so, it can be removed with blunt cerurents or a wire loop.

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Differential diagnosis

Differential diagnosis must be made between the different types of otitis. The two most common types are acute otitis media and otitis media with effusion. It is important to differentiate them during diagnosis, as the treatment is significantly different, especially with regard to the use of antibiotics. It is also necessary to differentiate between ear pain caused by inflammation and pain caused by earwax. This can be easily diagnosed even in the presence of a feverish reaction to an ear infection.

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Treatment earache in pregnancy

When choosing treatment for a pregnant woman, the doctor should remember that the benefit of taking medications should outweigh the potential danger. In other words, the fetus should not be exposed to excessive risk - otitis during pregnancy should be treated with the safest means. At the initial catarrhal stage of otitis, when the eardrum is not yet perforated and there is no pus, you may be prescribed local anti-inflammatory ear drops, such as Otipax or Otinum.

1. Otinum can be used as a pathogenetic therapy during pregnancy. The drug contains a derivative of salicylic acid - choline. The drug has an anti-inflammatory effect, reduces the severity of pain and reduces swelling. Method of application - in the form of ear drops locally in a warm form. The dosage is two drops four times a day in both ears, even if only one hurts. The drug is not absorbed into the blood and does not exhibit a systemic effect. But there may be side effects in the form of local tingling, burning, and allergic reactions. Precautions - although the drug does not have a systemic effect, however, during pregnancy it should be used with caution, not exceeding the dose.
2. Otipax during pregnancy is also a widely used remedy for the treatment of otitis. The drug contains phenazone and lidocaine. Phenazone has anti-inflammatory and decongestant properties, reduces irritation during otitis. Due to the content of lidocaine, pain is reduced and anxiety is reduced. The method of application of the drug is to use drops in each ear. Dosage - four drops three times a day. Side effects are rare, since the drug is not absorbed if the eardrum is intact. During pregnancy, it can be used for local treatment of otitis or for the treatment of pain after ear plugs.
3. Boric alcohol can be used during pregnancy if the ear pain is caused by the formation of a sulfur plug. In such cases, the use of boric alcohol is considered the best remedy. Due to its light alcoholic properties, the drug breaks down the bonds between the molecules of the sulfur plug, which allows it to dissolve. The method of using the drug is as follows: it is necessary to heat the alcohol to room temperature, moisten the turunda in alcohol and place it in the ear for ten minutes. In this case, a slight tingling or pinching may be felt, which is considered normal. After ten minutes, you need to remove the turunda, and you will feel how it becomes wet in the ear. After this, you need to carefully clean the external auditory canal with a stick.

On the advice of your doctor, you can insert warming tampons soaked in alcohol into your ear to reduce inflammation. In case of purulent external otitis, the pus is removed and the ear is disinfected with antiseptics suitable for pregnant women (eg, Miramistin). In case of severe swelling of the auditory tube, vasoconstrictor drops in doses for children (Nazivin, Simelin) should be used. If inflammation of the outer ear can develop into otitis media, you may be prescribed local antibiotic drops (Sofradex, Sulfaсyl sodium). You can also prescribe penicillin antibiotics such as Amoxicillin, Flemoxin. If you have a lot of pus, your doctor will puncture the eardrum in his office and disinfect the outer ear with alcohol, hydrogen peroxide or an antiseptic. Blowing out the auditory tube, pneumatic massage of the eardrum for 7-14 days also helps and is absolutely safe for both the woman and the fetus.

Folk remedies for ear pain

You can supplement the traditional therapy prescribed by your otolaryngologist with effective folk remedies. Any folk treatment should be used only after diagnosis and approval from your doctor. It is strictly forbidden to warm the ear or make compresses before you see your doctor, because in the case of purulent otitis, this can lead to serious complications. Some drugs at the perforation stage can cause big problems if they get into the inner ear. Therefore, folk remedies should be used with caution.

Traditional methods that use the following:

1. Both apple cider vinegar and white vinegar are known to be good fighters for all types of fungi. Vinegar works on fungal infection and removes it during drainage. Take one teaspoon of each vinegar and water and mix well.

Lie down on your side with the infected ear facing up. Now soak a cotton ball in the mixture and place it on the infected ear. Keep this compress for about 15 minutes and then remove the liquid by turning your head in the opposite direction. Dry your ear completely. If you do this twice a day, you will get rid of the infection within 2 or 3 days.

2. Earache from a cold can be relieved by placing a warm salt bag or a bottle of warm water on the infected ear. It works like a hot compress. But you should not do this if there is pus or you have not yet seen a doctor and do not know if there is pus. To put a salt bag, take 100 g of salt in a pan and heat it. Seal the salt in a clean cotton cloth and make a bag out of it. Place the bag on the ear and hold it until the heat is lost. This also reduces the feeling of pressure on the ear.
3. Garlic has antibacterial properties that can help fight off ear infections. Place three drops of garlic oil into the infected ear using a dropper. Garlic extract is a safe home remedy, but when the extent or severity of the infection is unknown, there is no clear indication that the home remedy will eliminate the infection.
4. Place two drops of olive or mineral oil in the infected ear. The oil breaks up the blocked wax, which then comes out of the ear quickly. If you continue to experience pain and the wax is too difficult to soften quickly, you should see a doctor.
5. Use hydrogen peroxide in the ear to relieve ear pain. Place 2 to 3 drops in the ear while lying down with the affected ear facing up. Stay in this position for about 10 minutes and you should feel relief.

Herbal treatments may also be used.

1. Boil a packet of thinly cut bay leaves in 300 ml of water for 10 minutes. Leave the infusion for two hours, then pour the leaves out of the infusion. Apply the infusion to a turunda and apply a few drops to rinse the ear.
2. Take a fresh geranium leaf, wash it, roll it into a tube and insert it into the ear. Keep the geranium in the ear for 1-2 hours. Such a dry compress will relieve inflammation and pain.
3. Make a tincture of propolis (1 part) and vegetable oil (2 parts). Apply 5 drops of the solution to each ear, cover the ears with cotton wool and leave the medicine in the ear canal for 15 minutes.

Surgery is the last and rare option doctors choose. If the ear infection does not go away, your doctor may have to perform surgery to drain the fluid from your middle ear. They will insert tubes into your ear to allow the excess fluid to drain. Removing the fluid will help you hear better and also relieve many of the associated symptoms. Surgery is also an option if the adenoids become extremely large and cause ear pain and inflammation.

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Prevention

Prevention of ear pain should begin with basic measures that prevent foreign bodies from getting into the ear canal. Do not submerge yourself completely in water while swimming to prevent water from getting into your ears, as water can be a source of infection. Try to keep your head above the water level. Use earplugs when swimming. Avoid scratching your ears and causing injury when cleaning the ear canal. Tilt your head when you get out of the pool to wipe off any remaining water. Dry your ears with a dry towel or hair dryer immediately after swimming. Since otitis is often a consequence of a viral infection or hypothermia, to prevent it, you need to avoid the flu and colds, dress for the weather and cover your head in the cold season. Even before pregnancy, you should strengthen your immune system, which requires more walking, proper nutrition, exercise and protection from colds. When taking a bath or shower, avoid getting water into the ear canal, as this reduces local immunity and often causes otitis.

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Forecast

The prognosis for ear pain during pregnancy is good for the baby, even if there is an infection. As long as the ear infection does not spread to the bloodstream, it will not affect your unborn baby. You can take medications to treat the infection that are safe and approved during this period.

Ear pain during pregnancy is not always a sign of otitis, sometimes it is simply a manifestation of a violation of the passage of the auditory tube or a complication after swimming in the pool. In any case, you need to consult a doctor to rule out complications. But even if there is an infection in the ear, there are medications that are allowed during pregnancy and will not harm your child.

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