History of Tympanosotomy Tube Placement in Children Referred to a Tertiary Autism Diagnostic Center

Background:  Tympanostomy tube placement (TTP) is the most common outpatient pediatric surgery performed in the United States, with nearly 1 in 15 children having tubes by the age of 3 years. Despite a lack of evidence to support TTP in improving developmental outcomes in previous studies that have excluded children with neurodevelopmental disorders, clinical guidelines have been published recommending tubes be offered to children with neurodevelopmental disorders, including speech/language disorders, global developmental delay, and autism spectrum disorder (ASD). However, the prevalence of TTP in children prior to receipt of a formal ASD diagnosis has not been previously reported.

Objectives:  To determine the prevalence of prior TTP in children referred for d

Methods:  The electronic medical records of all children ≤ 5 years of age evaluated at a single regional ASD diagnostic center between September 2012 and June 2014 were reviewed. History of TTP, clinical diagnoses, and demographic information was abstracted for each patient.

Results:  561 children (80% [N=450] male; 20% [N=111] female) with mean age of 44 months (SD 10 months) completed a diagnostic autism evaluation. Of those evaluated, 95 (17%) had a history of TTP. Of those patients with tubes, 61% (N=58) received an ASD diagnosis and 33% (N=31) were diagnosed with another neurodevelopmental disorder (speech/language disorder [N=11]; global developmental delay [N=20]).

Conclusions:  Our data indicate that 1 in 6 children presenting for diagnostic evaluation at a regional autism center have a history of prior TTP. Despite recently published guidelines advocating for TTP in children with neurodevelopmental disorders, given concerns about the potential negative neurodevelopmental impact of exposure to anesthesia/surgery further investigation into whether neurodevelopmental outcomes are improved in children with neurodevelopmental disorders who undergo TTP is needed, as previous studies on the impact of TTP have excluded this population of children.