Many autistic children complain of earaches and it is not uncommon for them to have multiple ear infections. Case reports in the literature suggest that treating the ear infection may help reduce some autistic behaviors (Tajima-Pozo et al., 2010). In many cases symptoms may be masked by the communication disorder and what may have been an easy to treat disorder snowballs into a worsening condition. According to a recent study (Adams DJ et al., 2016):
“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.”
It may be that children with autism may be predisposed by their condition to recurrent ear infections. However, it may also be possible that the treatment they received was inadequate. Basic question as to treatment of acute otitis media are still being argued in the medical literature. It is for this reason that I found a recent article in the New England Journal of Medicine of great interest. The article was entitled, “Treatment of Otitis Media: How Long Is Long Enough?” (Lehman D, 2016).
The authors of this study reported that young children with otitis media treated with antibiotics for 10 days did better than those treated for 5 days.
Researchers randomized 520 children aged 6–23 months with acute otitis media to receive amoxicillin-clavulanate (90.0 mg/kg amoxicillin, 6.4 mg/kg clavulanate) for 10 days or amoxicillin-clavulanate for 5 days followed by 5 days of placebo.
Children receiving 5-day antibiotic therapy had a higher rate of clinical failure (34%) than those in the 10-day treatment group (16%). No differences in adverse events or nasal colonization with resistant bacteria were noted between treatment groups.
References
Adams, D.J., Susi, A., Erdie-Lalena, C.R. et al. J Autism Dev Disord (2016) 46: 1636. doi:10.1007/s10803-015-2689-x
Lehman D. Treatment of Otitis Media: How Long Is Long Enough? NEJM December 22, 2016.
Tajima-Pozo K. Otitis and autism spectrum disorders. BMJ Case Reports 2010 pii: bcr1020092351. doi: 10.1136/bcr.10.2009.2351.