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Otitis Media and Related Complications Among Children with Autism Spectrum Disorders


Acute otitis media (AOM) symptoms can be masked by communication deficits, common to children with autism spectrum disorders (ASD). We sought to evaluate the association between ASD and otitis media. Using ICD-9-CM diagnostic codes, we performed a retrospective case-cohort study comparing AOM, and otitis-related diagnoses among children with and without ASD. Children with ASD had a significantly increased rate of AOM, otitis media with effusion, otorrhea, and PE tube placement. Children with ASD were more than twice as likely to develop mastoiditis, and to undergo mastoidectomy and tympanoplasty. Children with ASD are more likely to have middle ear infections and otitis-related complications, highlighting the importance of routine middle ear examinations and close attention to hearing impairment in this population.

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The authors would like to thank Martin Weisse and Virginia Randall for their assistance with reviewing and editing this manuscript.


This study was conducted with support from the Congressional Directed Medical Research Programs, Autism Research Award: W81XWH-12-2-0066.

Author Contributions

D.A. contributed to study design, created variable definitions, selected data acquisition instruments, assisted in the analysis, interpreted the results, and drafted the initial manuscript. A.S. performed data acquisition, statistical analysis, and reviewed the initial manuscript. C.E.L., B.H.G., G.G., M.E., and M.R. contributed to the study design, interpretation of results and reviewed the initial manuscript. C.N. contributed to study design, data acquisition, statistical analysis, interpretation of the results and reviewed the initial manuscript. All authors approved the final manuscript as submitted.

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Correspondence to Daniel J. Adams.

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The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest. The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Navy, United States Air Force, Department of Defense, or the U.S. Government. This research was presented in poster format at the Pediatric Academic Societies Meeting in San Diego, CA on April 27, 2015.

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Adams, D.J., Susi, A., Erdie-Lalena, C.R. et al. Otitis Media and Related Complications Among Children with Autism Spectrum Disorders. J Autism Dev Disord 46, 1636–1642 (2016).

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  • Autism spectrum disorders
  • Child development disorders, pervasive
  • Otitis media
  • Mastoiditis