Pregnancy, Deafness Link Is Discounted
A long-standing belief that getting pregnant will lead to deafness in women with a hearing defect called otosclerosis is most likely wrong, according to report presented this week at a conference in Florida.
The original idea that pregnancy was dangerous for such women came not from medical research, as most scientists think, but from a decision made by a high-ranking official in Nazi Germany’s eugenics program to remove people with genetic defects from the population, said Dr. William H. Lippy, an Ohio physician in private practice who conducted the study.
The key to disproving the link came from his observations of devout Jewish women in Israel, Lippy reported this week at a meeting of the Triological Society, an organization of ear, nose and throat doctors.
The tale is a lesson in how information that “everybody knows to be true” is handed down from one generation of physicians to the next without question, Lippy said. “What I practiced all these years, what many of my colleagues practiced, was wrong.”
Dr. Brad Welling of Ohio State University said: “This is good information, better than what we have ever had. In terms of family planning, however, it is not going to make a lot of difference.”
Treatment for otosclerosis is now so successful, he said, that most women with the disorder can feel free to have children whether the pregnancy exacerbates hearing loss or not.
However, Dr. Rick A. Friedman of the House Ear Institute in Los Angeles said that his experience made him more skeptical of Lippy’s findings.
“Each of us has gotten histories from women in which they noted onset of hearing loss during pregnancy or exacerbation,” he said. “I still think there is some association.”
But because of advances in treatment, he added, “there is simply no reason anymore to tell a woman not to get pregnant.... It is one of the disorders that can be readily fixed by a brief operation under local anesthesia.”
Otosclerosis is a problem with the stapes, one of the three bones of the inner ear -- commonly known as the hammer, anvil and stirrup. These bones carry sound vibrations from the eardrum to the inner ear.
In otosclerosis, for reasons that are unknown but that may be primarily genetic, the third bone in the series, the stapes or stirrup, becomes fixed in the inner ear. It is almost like the bone is cemented into place, preventing it from conducting sound efficiently.
The condition affects an estimated 500,000 Americans, two-thirds of them women. It once doomed its victims to a life of deafness, but it can now be ameliorated with hearing aids or, in more severe cases, with a stapedectomy, a brief procedure in which an artificial stapes is implanted in the ear.
Physicians have long believed that pregnancy exacerbates the condition. As late as 1950, abortion or sterilization was often offered to women as an alternative to their pregnancy, Lippy said. More recently, physicians have warned women that pregnancy could worsen the condition -- but that treatments are available.
Lippy began to question the common wisdom based on his experiences in Israel, where he teaches and practices several weeks each year.
“Many of the patients I saw were ultra-religious Jewish women who had multiple pregnancies -- five, six, eight, 10 children,” Lippy said. “We advised them not to have children and argued with the rabbis, but to no avail. Finally, I noticed that the hearing in those with multiple children was no worse than in those with none.”
Curious, he examined the records of 94 age-matched women in his own practice, 47 with children and 47 without. Using a variety of technical measures of their hearing, he concluded that the hearing of those who had children was no worse than that of those who did not.
The results could mean that age progression is more important than pregnancy in determining overall hearing loss, Friedman said. Even if pregnancy speeds up the hearing loss, “in the end, they all wind up at the same level.”
After his testing, Lippy tried to find the source of the belief. Ultimately, he tracked down a paper written in Germany in 1939. A conference of nine doctors had considered the cases of 79 pregnant women with otosclerosis.
“Only two of them believed that otosclerosis was really made worse by pregnancy,” Lippy said. “But a man from the Nazi Party wasn’t really interested in whether it was made worse by pregnancy. He made a eugenic decision. The rule was made that if a physician discovered a pregnant woman with otosclerosis, she had to be turned over to a government agency.”
Sixty-nine of the women were forced to have abortions, according to the paper, and many of them were sterilized. That decision filtered down through history, with the conclusions remaining, but the source fading.
Lippy’s results will have to be confirmed before being widely accepted, said Dr. Thomas J. Balkany of the University of Miami School of Medicine. “But at least now the question is out there,” he said.