Systematic review of structural ear anomolies and hearing impairment following prenatal alcohol exposure and in FASD

Background
Abnormalities of the internal and external ear structures, hearing impairment and auditory processing have been identified in FASD. A recent systematic review of comorbidities in FASD suggests that 4% of comorbidities can be accounted for by diseases of the ear and mastoid process, however no systematic review of the literature has been undertaken with a focus on the ear and hearing abnormalities. The aim of this study is to identify the range and prevalence of abnormalities in association with PAE and FASD.

Methods
Included articles were observational studies in children with PAE or FASD aged <18 years reporting quantitative data on measures or frequency of ear anomalies or hearing impairment. Excluded were reviews, case studies, animal studies, grey literature, monographs, studies where another condition/exposure was of primary interest (unless data were presented separately for PAE/FASD). Risk of bias was assessed using a 7-point critical appraisal tool. Quantitative data pertaining to structural ear abnormalities and hearing impairment, the frequency of impairment, and pathological assessment were recorded in relation to PAE or FASD diagnosis.

Results
The search strategy yielded 302 papers were included. Most (n=20) reported outcomes in children with FASD. Reported outcomes in children with PAE without FASD. Most studies were from Canada (n=8) and Sweden (n=7), with two from USA, and one each from Brazil, Chile, Italy, and Portugal; and one multi-site (international) study. Outcomes reported pertained to ophthalmologic findings (n=13) or eye tracking data (n=9). Analysis of results is continuing.

Relevance
This is the first systematically-conducted review in this area. The project is expected to provide:

• greater understand the eye abnormalities and impairments documented in children with PAE and/or FASD
• a new appreciation that behavioural and leaning difficulties observed in those with PAE and/or FASD may be compounded by difficulties with vision and visual processing
• evidence that clinicians should consider the utility of eye assessments in FASD screening

Project Partners: University of Sydney

Project Funder: FASD Research Australia Centre of Research Excellence