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Tympanostomy Tube Placement in Children with Autism Spectrum Disorder
Flora Yan1, Arnav Shah1, Glenn Isaacson1,2
1Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Insights
Children with autism spectrum disorder (ASD) have a higher rate of tympanostomy tube (TT) placement. This study explored TT placement frequency in US children with ASD compared to those without ASD.
Area of Science:
- Otolaryngology
- Pediatrics
- Developmental Pediatrics
Background:
- Tympanostomy tube (TT) placement is common in children.
- The frequency of TT placement in children with autism spectrum disorder (ASD) in the United States is not well-established.
- Understanding this frequency is crucial for healthcare planning and resource allocation.
Purpose of the Study:
- To determine the rate of TT placement in US children diagnosed with ASD.
- To compare the rate of TT placement in children with ASD versus those without ASD.
- To examine demographic and behavioral factors associated with TT placement in these groups.
Main Methods:
- Utilized data from the 2014 National Health Interview Survey (NHIS), a representative US sample.
- Included children under 18 years of age, identifying those with and without ASD and TT placement.
- Performed descriptive statistics and logistic regression analyses to compare groups.
Main Results:
- 11,730 children were analyzed, with 239 (2.0%) diagnosed with ASD.
- Children with ASD had a significantly higher rate of TT placement (14.2%) compared to children without ASD (8.6%), p=0.002.
- ASD diagnosis (OR 1.52), male sex, white race, and non-Hispanic ethnicity were associated with increased odds of TT placement.
Conclusions:
- Children with ASD exhibit an increased rate of tympanostomy tube placement compared to their peers without ASD.
- Potential reasons for this disparity include higher infection rates, diagnostic challenges in evaluating hearing, or treatment preferences in the ASD population.
- Further research is needed to elucidate the specific factors driving this increased utilization of TTs in children with ASD.
Objective:
The frequency of tympanostomy tube (TT) placement among United States children with autism spectrum disorder (ASD) is not known. We explored the rate of TT placement in children with ASD in the United States and compared this to children without ASD. We further examined demographic and behavioral factors that might vary between the two groups.
Methods:
We utilized data from the National Health Interview Survey (NHIS) administered in 2014. This survey samples a representative population of patients across the United States and includes children under 18 years of age. The 2014 version of the NHIS survey was chosen as it identifies both autism and TT placement among sampled patients. Descriptive statistics and univariable and multivariable logistic regression analyses were performed.
Results:
In total, 11,730 children (239 [2.0%] with ASD) were included. Overall, 34 (14.2%) children with ASD underwent TT placement versus 987 (8.6%) in children without ASD (p = 0.002) ASD diagnosis was associated with increased odds of TT placement (1.52 OR, 95% CI 1.04-2.22). Male sex, white race, and non-Hispanic ethnicity were also associated with increased odds of TT placement. Age at the time of TT surgery was not different between those with versus without ASD.
Conclusion:
Children with ASD have an increased rate of TT placement compared to children without ASD. The reason(s) for this increased rate might include the following: higher rates of infection in ASD, over-diagnosis of ear infection or hearing disability in a difficult-to-examine population, and/or a predilection toward aggressive treatment in this at-risk group.
Level Of Evidence:
3-National database study Laryngoscope, 133:2407-2412, 2023.
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