Frequencies of Myringotomy Procedures Among ASD Populations Compared to National Samples and the Role of Developmental Morphology (Low Set Ears)

Background: Findings from early studies in children with Autism Spectrum Disorders (ASD) have suggested ear abnormalities to be a discriminating factor between ASD and normal controls (Rodier et al., 1997). Previous investigations have suggested that low-set ears may be associated with chronic and problematic otitis media in children with ASD (Konstantareas & Homatidis,1987). The examination of frequency of myringotomy procedures for the treatment of chronic and severe otitis media in children with ASD could provide further information into the nature of chronic OM in ASD populations. Furthermore, examining ear placement in children with ASD in relation to controls in the context of myringotomy procedure may be utilized to serve as a clinical marker for ASD symptomology or aid in identifying specific subgroups. 

Objectives: The objectives of the current study are twofold. The first aim is to investigate frequency of myringotomy procedures among ASD populations compared to a verified normative sample to identify potential fit-related differences that could be indicative of specific aspects of ASD populations. The second aim is to compare ear position of ASD children in the sample to their unaffected siblings to examine the hypothesis that children with ASD will have higher incidence of low-set ears that may contribute to difficulties with chronic otitis media and myringotomy procedures.

Methods: To address aim 1, we investigated the occurrence of myringotomy procedures among 1650 (1429M; 221F) children with ADI and ADOS-confirmed ASD diagnoses between the ages of 3 and 18 years ascertained through the Simons Simplex Collection (distribution 8.2; http://SFARI.org). Frequencies were then compared to myringotomy tube placement procedures from the National Hospital Ambulatory Medical Care and National Ambulatory Medical Care Surveys for 2003– 2005 and the 2003 Kids’ Inpatient Database (KID). To address aim 2, analyses are ongoing and include the comparison of ear placement in 40 children with ASD (both with and without myringotomy procedures) to their same age closest age siblings. Measurements are conducted on 2D side view photographs that capture both sides of the head to ensure landmarks of the nose, eyebrow ridge, and eyes are visible and measureable.

Results: A chi-square test of goodness-of-fit test was performed to compare myringotomy procedure frequencies between the two groups. Myringotomy procedure for both groups was not equally distributed in the population. ASD children had significantly more myringotomy procedures than their typically developing peers, χ² (1, N = 1650) = 1679.17, p < .001. The difference was also present when rates were examined individually for males (χ² (1, N = 1429) = 1556.44, p < .001) and females (χ² (1, N = 221) = 135.68, p < .001). Data collection and analysis of ear placement in children with ASD both with and without myringotomy procedures are ongoing.  

Conclusions: Results from the current study suggest that myringotomy procedures occur with significantly greater frequency in ASD populations compared to that of normative populations. Better understanding of the factors underlying this increased rate could enhance early identification and screening methods used to assess children with developmental deficits associated with ASD and OM.