J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 7, July 2025, pages 386-397

Risk Factors in the Formation of Congenital Malformations of the Ear: Microtia and Atresia of the External Auditory Canal

↓ **Table 1.** Demographic and Clinical Profile With Incidence of CEM Among Neonates in Two Public Hospitals in Kazakhstan
Variables	Without CEM	With CEM	Incidence rates
CEM: congenital ear malformation.
Male	484 (97.38%)	13 (2.62%)	26.86 cases per 1,000 males
Female	466 (49.05%)	12 (50.95%)	25.75 cases per 1,000 females
Age (days)	1.2 ± 0.5	1.3 ± 0.6	-
Weight (kg)	3.2 ± 0.4	2.8 ± 0.6	-
Comorbidities	910 (98.48%)	14 (1.52%)	-
Total	950 (97.44%)	25 (2.56%)	26.30 cases per 1,000 persons

↓ Table 1. Demographic and Clinical Profile With Incidence of CEM Among Neonates in Two Public Hospitals in Kazakhstan

Variables

Without CEM

With CEM

Incidence rates

CEM: congenital ear malformation.

Male

484 (97.38%)

13 (2.62%)

26.86 cases per 1,000 males

Female

466 (49.05%)

12 (50.95%)

25.75 cases per 1,000 females

Age (days)

1.2 ± 0.5

1.3 ± 0.6

Weight (kg)

3.2 ± 0.4

2.8 ± 0.6

Comorbidities

910 (98.48%)

14 (1.52%)

Total

950 (97.44%)

25 (2.56%)

26.30 cases per 1,000 persons

↓ **Table 2.** Medical and Social Determinants of Congenital Ear Malformation
Characteristics	Without CEM	With CEM	P value
CEM: congenital ear malformation.
Sex
Male	484	97.38	13	2.62	0.385
Female	466	49.05	12	50.95
Parental consanguinity
No	760	98.45	12	1.55	0.001
First degree	120	92.31	10	7.69
Second degree and more	70	95.89	3	4.10
Maternal employment
No	930	97.48	24	2.5	0.050
Yes	20	95.24	1	4.765
Dysmorphia
No	930	97.38	25	2.62	0.550
Yes	20	100	0	0.0
Maternal smoking
No	785	98.13	15	1.88	0.344
Yes	165	94.29	10	5.71
Maternal alcohol consumption
No	944	97.82	21	2.176	0.020
Yes	10	71.43	4	28.571
Premature birth
No	650	97.6	16	2.402	0.270
Yes	300	97.09	9	2.913
Cesarean section
No	610	97.76	14	2.244	0.000
Yes	340	96.87	11	3.134
Stillbirth
No	930	97.89	20	2.105	0.005
Yes	20	80	5	20
Iron supplementation during pregnancy
No	150	96.77	5	3.226	0.179
Yes	800	97.56	20	2.439
Calcium intake during pregnancy
No	200	95.69	9	4.306	0.213
Yes	750	97.91	16	2.089
Vitamin supplementation
No	820	97.39	22	2.613	0.333
Yes	130	97.74	3	2.256
Medication during pregnancy
No	810	98.18	15	1.818	0.002
Yes	140	93.33	10	6.667

↓ Table 2. Medical and Social Determinants of Congenital Ear Malformation

Characteristics

Without CEM

With CEM

P value

CEM: congenital ear malformation.

Sex

Male

484

97.38

2.62

0.385

Female

466

49.05

50.95

Parental consanguinity

760

98.45

1.55

0.001

First degree

120

92.31

7.69

Second degree and more

95.89

4.10

Maternal employment

930

97.48

2.5

0.050

Yes

95.24

4.765

Dysmorphia

930

97.38

2.62

0.550

Yes

100

0.0

Maternal smoking

785

98.13

1.88

0.344

Yes

165

94.29

5.71

Maternal alcohol consumption

944

97.82

2.176

0.020

Yes

71.43

28.571

Premature birth

650

97.6

2.402

0.270

Yes

300

97.09

2.913

Cesarean section

610

97.76

2.244

0.000

Yes

340

96.87

3.134

Stillbirth

930

97.89

2.105

0.005

Yes

Iron supplementation during pregnancy

150

96.77

3.226

0.179

Yes

800

97.56

2.439

Calcium intake during pregnancy

200

95.69

4.306

0.213

Yes

750

97.91

2.089

Vitamin supplementation

820

97.39

2.613

0.333

Yes

130

97.74

2.256

Medication during pregnancy

810

98.18

1.818

0.002

Yes

140

93.33

6.667

↓ **Table 3.** Level of Medical Care Provided to Children With CEM, Including Surgical and Non-Surgical Treatment Modalities and Their Frequencies and Percentages
Level of treatment	Treatment method	Frequency of CEM	Percentage
CEM: congenital ear malformation.
Surgical	Surgical reconstruction	15	60%
	Cochlear implants	2	8%
Non-surgical	Prosthetic solutions	5	20%
	Hearing aids	20	80%
	Bone-anchored hearing aid (BAHA)	3	12%
	Speech therapy	25	100%
	Counseling and support	25	100%

↓ Table 3. Level of Medical Care Provided to Children With CEM, Including Surgical and Non-Surgical Treatment Modalities and Their Frequencies and Percentages

Level of treatment

Treatment method

Frequency of CEM

Percentage

CEM: congenital ear malformation.

Surgical

Surgical reconstruction

60%

Cochlear implants

Non-surgical

Prosthetic solutions

20%

Hearing aids

80%

Bone-anchored hearing aid (BAHA)

12%

Speech therapy

100%

Counseling and support

100%

↓ **Table 4.** Risk Factors of Congenital Malformations and Multivariate Analyses
Dependent variable	Independent variables	OR	95% CI	P value	R²
For each dependent variable (e.g., CEM, stillbirth, Apgar score, etc.), the corresponding independent variables (such as parental consanguinity, maternal alcohol consumption, medication during pregnancy, etc.) have been retained and clearly displayed. CEM: congenital ear malformation; OR: odds ratio; CI: confidence interval.
CEM	Parental consanguinity	4.56	0.84, 3.10	0.087	0.11
	Maternal alcohol consumption	12.73	1.81, 46.73	0.005
	Medication during pregnancy	22.84	1.19, 10.42	0.002
Stillbirth	CEM	16.21	1.67, 19.79	0.003	0.12
	Cesarean section	4.56	0.90, 3.00	0.048
	Abortions	7.18	1.19, 2.10	0.003
Apgar score	Number of live children	1.13	0.05, 0.20	0.004	0.02
	Maternal smoking	0.65	-0.66, -0.12	0.010
	Vitamin supplementation	1.36	0.19, 0.79	0.009
	Iron supplementation during pregnancy	1.51	0.04, 0.63	0.034
	Parental consanguinity	0.77	0.74, 0.01	0.050
Child weight	Maternal smoking	0.85	-310.91, -149.57	0.002	0.03
	Caesarean section	0.78	-126.72, -10.30	0.001
Cranial perimeter	Dysmorphia	4.15	0.74, 1.199	0.005	0.05
	CEM	1.22	0.05, 0.020	0.006
	Abortions	0.71	-0.63, -0.05	0.010
	Maternal smoking	0.84	-0.41, -0.01	0.034

↓ Table 4. Risk Factors of Congenital Malformations and Multivariate Analyses

Dependent variable

Independent variables

95% CI

P value

R²

For each dependent variable (e.g., CEM, stillbirth, Apgar score, etc.), the corresponding independent variables (such as parental consanguinity, maternal alcohol consumption, medication during pregnancy, etc.) have been retained and clearly displayed. CEM: congenital ear malformation; OR: odds ratio; CI: confidence interval.

CEM

Parental consanguinity

4.56

0.84, 3.10

0.087

0.11

Maternal alcohol consumption

12.73

1.81, 46.73

0.005

Medication during pregnancy

22.84

1.19, 10.42

0.002

Stillbirth

CEM

16.21

1.67, 19.79

0.003

0.12

Cesarean section

4.56

0.90, 3.00

0.048

Abortions

7.18

1.19, 2.10

0.003

Apgar score

Number of live children

1.13

0.05, 0.20

0.004

0.02

Maternal smoking

0.65

-0.66, -0.12

0.010

Vitamin supplementation

1.36

0.19, 0.79

0.009

Iron supplementation during pregnancy

1.51

0.04, 0.63

0.034

Parental consanguinity

0.77

0.74, 0.01

0.050

Child weight

Maternal smoking

0.85

-310.91, -149.57

0.002

0.03

Caesarean section

0.78

-126.72, -10.30

0.001

Cranial perimeter

Dysmorphia

4.15

0.74, 1.199

0.005

0.05

CEM

1.22

0.05, 0.020

0.006

Abortions

0.71

-0.63, -0.05

0.010

Maternal smoking

0.84

-0.41, -0.01

0.034

↓ **Table 5.** Theme and Sub-Themes of Quality of Life of Children With CEM
No.	Theme	Sub-themes
CEM: congenital ear malformation.
1	Physical challenges	Discomfort in ears
		Hearing difficulties
		Energy levels
2	Emotional impact	Self-consciousness
		Anxiety
		Frustration
3	Social interactions	Peer acceptance
		Participation in social activities
		Friend support
4	Functional limitations	Difficulty with specific tasks
		Activity limitations

↓ Table 5. Theme and Sub-Themes of Quality of Life of Children With CEM

No.

Theme

Sub-themes

CEM: congenital ear malformation.

Physical challenges

Discomfort in ears

Hearing difficulties

Energy levels

Emotional impact

Self-consciousness

Anxiety

Frustration

Social interactions

Peer acceptance

Participation in social activities

Friend support

Functional limitations

Difficulty with specific tasks

Activity limitations