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• Posted April 25, 2023

Could Ear, Nose & Throat Issues Play a Role in Autism?

Researchers have long tried to pinpoint a reason that some people have autism or autistic traits.

A new study from the United Kingdom builds upon evidence about one potential factor, finding that young children with ear, nose and throat problems were more commonly diagnosed with autism later.

This isn't to say that all young kids who have ear infections will eventually be diagnosed with autism. It also doesn't mean that all people with autism had these upper respiratory infections as a young child.

But this could be part of a long list of potential reasons, working together in various combinations, according to investigators at the University of Bristol and Aston University in England.

"Clearly by themselves, ear infections or these chronic ear problems or differences are not causing autism, but it may be a combination of things,"said Alycia Halladay, chief science officer for the Autism Science Foundation in Scarsdale, N.Y. "So we need to start looking at what those combinations are."Halladay was not involved in this new study.

For one symptom -- snoring -- about 1,700 children did so when they were 2-1/2 years old, according to their moms. But most -- about 1,660 -- of those kids were not later diagnosed with autism.

"Most children with signs of ear infection are not autistic so it would not help to screen those with infections,"said study author Dr. Amanda Hall, honorary senior research fellow at Bristol Medical School and senior lecturer in audiology at Aston University in Birmingham, England. "However, it could be helpful to ensure children with autism are regularly checked for common ear, nose and throat conditions."

The researchers studied these associations using data from more than 10,000 children included in the Children of the 90s study in the United Kingdom. That study followed kids born in the early 1990s from the Bristol area.

The authors for the current study identified 177 young kids with a probable diagnosis of autism who were part of that dataset.

Their moms had answered questionnaires about frequency of nine signs and symptoms related to their children's ears, hearing problems and upper respiratory system when they were about 1-1/2 to 3-1/2 years old.

Symptoms included snoring, mouth breathing, pulling or poking at their ears, ears getting red and sore, having worse hearing during a cold, ear discharge and rarely listening.

Higher frequency of these symptoms was associated with higher scores on autism traits like impaired social communication, incoherent speech and repetitive behaviors, and with a clinical diagnosis of autism. This link was especially evident at age 30 months.

Certain symptoms were more commonly associated with autism.

Kids who had pus or sticky mucus discharge from their ears had triple the risk of autism. Those who had impaired hearing during a cold had more than twice the risk.

Although the study didn't explore exactly why children with these upper respiratory infection issues might be more likely to have autism, Hall said one explanation could be differences in the structure and positioning of the ear. This is known to be different, at a group level, in people with autism and could increase the risk of having ear, nose and throat conditions, she said.

Many questions remain. "This study does not allow us to differentiate between whether ear, nose and throat issues are related to the later development of autism, or whether they are co-occurring conditions in autistic people,"Hall said.

In the United States, about 1 in 36 children has an autism spectrum disorder. Symptoms can range from mild to profound, with boys diagnosed more often than girls.

Among the many suggestions for what might contribute to autism are genetics and mothers' immune challenges during pregnancy, Halladay said. This new research adds to that, she noted.

Whether parents have concerns about autism or not, they should take their child to a pediatrician when symptoms of an ear infection surface, Halladay said.

Also, there is no harm in carefully watching a child who has had chronic ear infections, she added.

"We know that chronic ear infections can impede hearing during development,"Halladay said. That may impact speech and language. It doesn't hurt to pay attention to how a child's language skills are developing, she explained.

Hall said it's important to be aware that ear, nose and throat signs and symptoms are more common in children with autism, and to ensure they're promptly identified and treated.

Also needed is "research to understand how best to identify and manage ear, nose and throat conditions in autistic children, and whether early intervention leads to benefit,"Hall added.

The study results were published online April 24 in the BMJ Open.

More information

The U.S. Centers for Disease Control and Prevention has more on autism spectrum disorder.

SOURCES: Amanda Hall, PhD, honorary senior research fellow, Bristol Medical School and senior lecturer in audiology, Aston University, Birmingham, United Kingdom; Alycia Halladay, PhD, chief science officer, Autism Science Foundation, Scarsdale, N.Y.; BMJ Open, April 24, 2023, online