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Association between early childhood symptoms of common ear, nose and throat problems and autism – new research

Apr 25, 2023

3 min

Dr Amanda Hall



  • Researchers find an association between autistic traits and young children with ear, nose and throat problems
  • The study used data from the Children of the 90s study which found 177 children were identified with a probable diagnosis of autism – 139 boys and 38 girls
  • The study looked at data from over 10,000 children from birth to four years old.


Ear, nose and throat (ENT) problems, relating to the ears, hearing and the upper respiratory system, are more common in young children with a subsequent diagnosis of autism, or who have demonstrated high levels of autism traits - finds new research published in BMJ Open.


The study, which was led by researchers from the University of Bristol and Aston University, looked at data from over 10,000 young children from birth to four years old, who were part of the Bristol’s Children of the 90s study. The team investigated whether early ear and upper respiratory signs are associated with the development of autistic traits.


Previous studies have found increased prevalence of ENT and related hearing conditions in children with autism compared with typically developing children, but much of this research has been carried out using health records, which can be biased.


In the new study, researchers used data from Children of the 90s study, a general population cohort which recruited over 14,000 pregnant women from the Bristol area between 1991 and 1992 and has followed the lives of their offspring ever since.

Within Children of the 90s, 177 children were identified with a probable diagnosis of autism – 139 boys and 38 girls. Those with autism traits were defined as the 10% of the sample with the highest trait scores.


The team analysed responses to three questionnaires in which mothers recorded the frequency of nine different signs and symptoms relating to the ears, hearing problems and upper respiratory system when their child was aged 18 to 42 months. These included signs such as mouth breathing, snoring, pulling/poking of the ears, ears going red, worse hearing during a cold, ear discharge and rarely listening.


The results found that the frequency of these symptoms was associated with high scores on each of the autism traits: social communication, coherent speech, sociability and repetitive behaviours, plus those with a clinical diagnosis of autism. Pus or sticky mucus discharge from the ears was especially associated with autism (an increased risk of 3.29) and for impaired hearing during a cold (an increased risk of 2.18).


Dr Amanda Hall, senior lecturer in audiology, at Aston University, said: “Thanks to the data available from Children of the 90s, we were able to analyse results from a large number of children. We found that common ear and upper respiratory signs and symptoms appear to be more prevalent in those with a subsequent diagnosis of autism or demonstrated high levels of autism traits.

“However it is also important to note that these ENT symptoms are very common in childhood and most children who experience these signs and symptoms do not go on to be diagnosed with autism.

“For example, of the group of around 1,700 children who snored at age 30 months, most of those 1,660 children did not get a later diagnosis of autism. Our results suggest the need for increased awareness of possible ENT conditions.”


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Dr Amanda Hall

Dr Amanda Hall

Lecturer, Audiology

Dr Hall's research focuses on the causes and impact of hearing loss in children, at both the individual and the population level.

AudiologyShared Decision MakingAudiology Health Services ResearchCauses and Impact of Childhood Hearing LossLongitudinal Cohort Studies
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