Ear Abnormalities among Children with Fetal Alcohol Spectrum Disorder: A Systematic Review and Meta-Analysis.

Objective To systematically review and conduct meta-analysis on studies that report the type and prevalence of functional and structural ear abnormalities among children with prenatal alcohol exposure and/or fetal alcohol spectrum disorder (FASD). Study design MEDLINE, PubMed, Embase, Web of Science, PsycINFO, ERIC, CINAHL, and Maternity and Infant Care were searched from 1806 through March 2021. Reference lists of relevant articles were manually searched. Studies reporting on functional and/or structural ear abnormalities among children (less than 18 years) with PAE and/or FASD were eligible. Data extraction and quality assessment were performed by one reviewer and independently checked by another. Random-effects meta-analysis was conducted. Results A total of 31 studies met inclusion criteria and 25 were included in the meta-analyses, representing a total of 843 children with PAE and 1653 children with FASD. Functional ear abnormalities with the highest pooled prevalence were chronic serous otitis media (88.5%, 95% CI 70.4-99.3%), abnormal auditory filtering (80.1%, 95% CI 76.5-84.3%), and unspecified conductive hearing loss (68.0%, 95% CI 51.9-82.2%). Structural ear abnormalities with the highest pooled prevalence were microtia (42.9%, 95% CI 26.8-59.7%), railroad track ear (16.8%, 95% CI 8.1-27.7%), and misplaced ear (12.3%, 95% CI 7.6-17.9%). Conclusions Our findings highlight the importance of examining the ears during assessment for FASD, and the need for public health messaging regarding the harms of PAE.