A connection between ear, nose, and throat (ENT) issues in early childhood and autism has been detected.
A study, conducted by researchers at the University of Bristol and Aston University in Birmingham, published in BMJ Open, analysed data from more than 10,000 young children up to the age of four years from the Children of the 90s study, which was carried out in Bristol.
The researchers aimed to determine if early ear and upper respiratory signs were associated with the development of autistic traits.
The study identified 177 children with a probable diagnosis of autism, consisting of 139 boys and 38 girls.
Autism traits were defined as the 10 per cent of the sample with the highest trait scores.
The researchers found that the frequency of certain ENT symptoms, such as breathing through the mouth, snoring, ear pulling/poking, ears going red, deterioration of hearing during a cold, ear discharge and rarely listening was associated with high scores on each of the autism traits and those with a clinical diagnosis of autism.
The results revealed that pus or sticky mucus discharge from the ears was especially associated with autism, with an increased risk of 3.29, and impaired hearing during a cold showed an increased risk of 2.18.
However, researchers it is crucial to note that these ENT symptoms are common in childhood, and most children experiencing these signs and symptoms do not go on to be diagnosed with autism.
Dr Amanda Hall, a senior lecturer in audiology at Aston University, emphasised the need for increased awareness of possible ENT conditions.
She said: “I think what [the study] does do is it adds to the pattern of results that have been reported in the literature for a long time, that children with autism have different early history than children who aren’t autistic.”
Dr Hall told The National that one possible explanation for the observed link was that “differences in the structure and positioning of the ear, which is known to be different [at a group level] in autistic people, could increase the risk of having ENT conditions.”
The study does not prove that these conditions cause autism or that children with autism are more likely to suffer from these illnesses. It does, however, add to the pattern of results reported in the literature indicating that autistic children have a different early medical history compared to non-autistic children.
The research team used data from the Children of the 90s study, which followed the lives of more than 14,000 offspring of pregnant women from the Bristol area, recruited between 1991 and 1992.
Mothers completed questionnaires about the frequency of nine varying signs and symptoms related to ears, hearing problems and the upper respiratory system when their children were aged 18 to 42 months.
Dr Hall told The National: “We used a statistical technique in which the analysis looked at the relationship between the ENT signs and autism, and also took account of these 10 factors in the analysis.
“They were chosen based on factors that could influence the relationship between ENT signs/symptoms and autism.”
The study provides new insight into the potential association between early childhood ENT symptoms and autism, paving the way for considering treatment pathways for ENT problems in autistic children in general practice and secondary care.
However, the study has some methodological challenges, including the full impact of environmental factors and relying on self-reported data provided by mothers, which may not accurately reflect symptoms.
Dr Hall spoke about the limitations to The National. “As in all longitudinal studies, there was loss of children to later follow-up, so missing data could bias the findings," she said.
“The study includes very few ethnic minority families, which could limit the generalisability. Information on autism was obtained from a variety of sources, rather than all children having an autism assessment, which could have affected the findings.”
