Main Article Content
Fetal alcohol spectrum disorder, fetal alcohol syndrome, hearing, children, audiology
Alcohol is the most prevalent human teratogen affected by early exposure of the fetus. Although not listed as a major part of the fetal alcohol spectrum disorder (FASD), different texts list hearing loss as a characteristic of the FASD, based on several small studies.
To characterize hearing in children with FASD, diagnosed in the Motherisk Program in Toronto.
Cross sectional cohort study.
Academic referral center.
Children 4-16 years of age that met criteria for FASD, with no other known risk factor for sensorineural hearing loss. A consecutive sample of 41 children (13 girls, mean age 8.9±3 years) was collected. Intervention: Physical examination, audiometry and tympanometry. Outcome measures: External and middle ear pathology on physical examination, pure tone average (PTA), speech reception threshold (SRT), discrimination and tympanometry. Results were compared to reference values in the normal population. Hearing loss equal or greater than 16dB hearing-level in each frequency tested was considered to be clinically significant.
A total of 5 (11.2%) of children had hearing loss of at least 16dB hearing–level, mostly unilateral. SRT was within the normal range in 40 (98%) of children with FASD and discrimination was normal in all children. None had auricular or external canal dysmorphology. 14.7% of the children had frequent episodes of acute otitis media. Middle ear effusion was detected in 8 ears (9.8%).
The prevalence of mild sensorineural hearing loss in children diagnosed with FASD (16dB hearing-level or greater) was not higher than expected in this age group. However, because children with FASD are academically and behaviorally challenged, early detection of hearing loss and early intervention is warranted.
2. Abel EL. Fetal alcohol syndrome. Oradell, N.J: Medical Economics Books; 1990.
3. Abel EL. An update on incidence of FAS: FAS is not an equal opportunity birth defect. Neurotoxicol Teratol 1995;17:437-443.
4. Sampson PD, Streissguth AP, Bookstein FL et al. Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology 1997;56:317-326.
5. Church MW, Abel EL, Kaltenbach JA, Overbeck GW. Effects of prenatal alcohol exposure and aging on auditory function in the rat: preliminary results. Alcohol Clin Exp Res 1996;20:172-179.
6. Church MW, Gerkin KP. Hearing disorders in children with fetal alcohol syndrome: findings from case reports. Pediatrics. 1988;82:147-154.
7. Church MW. Chronic in utero alcohol exposure affects auditory function in rats and in humans. Alcohol 1987;4:231-239.
8. Rossig C, Wasser S, Oppermann P. Audiologic manifestations in fetal alcohol syndrome assessed by brainstem auditory- evoked potentials. Neuropediatrics 1994;25:245- 249.
9. Niskar AS, Kieszak SM, Holmes A, Esteban E, Rubin C, Brody DJ. Prevalence of hearing loss among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey. JAMA 1998;279:1071-1075.
10. Burd L, Klug MG, Martsolf JT, Kerbeshian J. Fetal alcohol syndrome: neuropsychiatric phenomics. Neurotoxicol Teratol 2003;25:697-705.
11. Autti-Ramo I, Fagerlund A, Ervalahti N, Loimu L, Korkman M, Hoyme HE. Fetal alcohol spectrum disorders in Finland: clinical delineation of 77 older children and adolescents. Am J Med Genet A 2006;140:137-143.
12. Nash K, Rovet J, Greenbaum R, Fant us E, Nulman I, Koren G. Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Arch Women’s Ment Health 2006;9:181 -186.
13. Stromland K. Visual impairment and ocular abnormalities in children with fetal alcohol syndrome. Addict Biol 2004;9:153-157.
14. Hoyme HE, May PA, Kalberg WO, et al . A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: clarification of the 1996 institute of medicine criteria. Pediatrics 2005;115:39-47.
15. Church MW, Kaltenbach JA. Hearing, speech, language, and vestibular disorders in the fetal alcohol syndrome: a literature review. Alcohol Clin Exp Res 1997;21(3):495 -512. ,
16. O'Leary CM. Fetal alcohol syndrome: Diagnosis, epidemiology, and developmenta l outcomes. J Paediatr Child Health 2004;40:2-7.
17. Cone-Wesson B. Prenatal alcohol and cocaine exposure: Influences on cognition, speech, language, and hearing. J Commun Disord 2005
18. Church MW, Abel EL. Fetal alcohol syndrome: Hearing, speech, language, and vestibular disorders. Obstet Gynecol Clin North Am 1998;25(1):85 -97.
19. Church MW, Eldis F, Blakley BW, Bawle EV. Hearing, language, speech, vestibular, and dentofacial disorders in fetal alcohol syndrome. Alcohol Clin Exp Res 1997;21:227 -237.