When the Ears Speak: Otorhinolaryngological Clues in Autism Spectrum Disorder

Abstract Objective of the Review 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 Findings 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. Summary Integration of current evidence shows that otorhinolaryngological manifestations are frequent and clinically relevant components of ASD, although their causal role remains to be fully elucidated. Early identification of sleep disorders, auditory hypersensitivity, and alterations in taste and smell can support more comprehensive clinical assessment and guide multidisciplinary interventions. Recognizing these dysfunctions within an integrated sensory and neurobiological framework, rather than as isolated findings, may improve clinical care and inform future research on potential sensory markers and intervention strategies.