THE DIAGNOSIS AND TREATMENT OF RHINOSINUSITIS DURING PREGNANCY AND LACTATION

Abstract

Upper airway congestive symptoms during have been recognized since the turn of the century. 60 Among randomly selected pregnancies, as many as 30% of patients report substantial symptoms of rhinitis and rhinosinusitis, and this figure may be higher among patients with pre-existing atopic disease. 21,58,59 Rhinitis of pregnancy can take many forms. The incidence of allergic rhinitis among women of childbearing years is approximately 20%. 82 Of those pregnant women with known allergies, some studies suggest that approximately 10% will experience increasing allergic symptoms during their and 90% will remain the same. 35,94 Other rhinitis presentations in include rhinosinusitis, rhinitis medicamentosa, and the ill-defined vasomotor rhinitis . Further complicating the picture is the fact that the frequency of sinusitis may be as high as 1.5% in pregnancy, which represents a sixfold increase over the frequency observed in a nonpregnant population. 91 Pregnant women also tend to develop rhinitis medicamentosa, complicating other rhinitis syndromes, probably because of their tendency to use exclusively topical medications to protect their fetuses. 50 A more nonspecific form of rhinitis is described by some pregnant women as nasal stuffiness with some dryness and episodes of epistaxis. This form has been given the confusing term vasomotor rhinitis , which implies an alteration of the natural integrity of the vasomotor or secretomotor function of the nose; however, nasal vascular pooling secondary to the increased circulating blood volume and perhaps other nasal reactive enhancement properties induced by maternal hormones have been forwarded as more likely mechanisms. There is understandable reluctance on the part of physicians caring for pregnant patients to employ the modalities commonly used in the diagnosis and management of rhinitis because of fetal risk factors, the time-limited nature of pregnancy, and the litigious nature of the American public. There are few data regarding the clinical effect of the various forms of rhinitis on pregnancy. On the surface it seems unlikely that gestational forms of rhinitis would have a deleterious effect on the course of pregnancy; however, uncontrolled atopic rhinitis or sinusitis during may aggravate coexisting asthma, which can have a distinct adverse effect on outcome. Furthermore, the risk of sinusitis and the impact rhinitis may have on the pregnant mother's eating, sleeping, and emotional well-being could be significant, suggesting that rhinitis during should be actively evaluated and treated to optimize outcome.