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

Press release issued: 24 April 2023

ENT (ear, nose and throat) problems relating to the ears, hearing and upper respiratory system, were found to be more common in young children with a subsequent diagnosis of autism or who demonstrated high levels of autism traits, finds a new study from researchers at the University of Bristol and Aston University published today [24 April] in BMJ Open.

Researchers looked at data from over 10,000 young children aged between birth and 4 years old from Bristol’s Children of the 90s study, to investigate whether early ear and upper respiratory signs are associated with the development of autistic traits.

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.

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 this 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 followed the lives of their offspring ever since.

The team analysed responses to three questionnaires in which mothers had 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.

Their results found 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, honorary senior research fellow at Bristol Medical School and 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 1700 children who snored at age 30 months, most of them (1660 children) did not get a later diagnosis of autism. Results suggest the need for increased awareness of possible ENT conditions.”     

Parents and carers with concerns about common ENT symptoms in their children or concerns about autism should follow NHS advice:


Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the ALSPAC geographically defined childhood population’ by Hall al in BMJ Open [open access]

Further information

About Children of the 90s
Based at the University of Bristol, Children of the 90s, also known as the Avon Longitudinal Study of Parents and Children (ALSPAC), is a long-term health research project that enrolled more than 14,000 pregnant women in 1991 and 1992.  It has been following the health and development of the parents, their children and now their grandchildren in detail ever since.  It receives core funding from the Medical Research Council, the Wellcome Trust and the University of Bristol.

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