When the Ears Speak: Otorhinolaryngological Clues in Autism Spectrum Disorder
Abstract
To investigate the otorhinolaryngological manifestations associated with Autism Spectrum Disorder (ASD), exploring how dysfunctions in sleep, hearing, smell, and taste may act as relevant sensory and clinical markers. This review also aims to contextualize these findings within a sensory integration framework and to discuss their clinical relevance beyond isolated peripheral alterations. Recent studies indicate a high prevalence of sleep disturbances (50–80%), auditory hypersensitivity (around 37%), and olfactory and gustatory alterations in children with ASD, influencing food selectivity and social behavior. Sleep disturbances include not only insomnia but also sleep-disordered breathing and may be associated with alterations in melatonin synthesis, serotonergic imbalance, and broader neurochemical dysregulation. Research using both animal and clinical models suggests that dysfunctions in GABAergic and serotonergic systems, as well as abnormal melatonin secretion patterns, contribute to sensory and sleep dysregulation. Auditory abnormalities extend beyond peripheral hearing loss and include central auditory processing differences and hypersensitivity to sound. Advances in combined therapies such as prolonged-release melatonin, cognitive behavioral therapy, and family-based approaches have demonstrated clinical benefits. Integration of current evidence shows that otorhinolaryngological manifestations are frequent and clinically relevant components of ASD, although their…
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