Objective: To understand rate of tympanostomy tube placement (TTP) in children with autism spectrum disorder (ASD) and, if different from rate of TTP in the general population, consider reasons underlying the difference. Methods: Questions pertaining to TTP were asked during caregiver interview. Totally, 2080 children with ASD were characterized through collection of demographic information; medical history; and cognitive, adaptive, and behavioral assessments. Frequencies of TTP in the ASD sample were compared with general population rates according to the most recent literature. Relationships between TTP and factors that may impact the rate of TTP were investigated. Results: Totally, 15.5% of children with ASD received TTP. The older the age, the higher the rate of TTP, with 17.0% of children aged 13 to 17 years having received TTP. Chi-square results comparing general population TTP rates to the sample indicated significantly higher rates among the ASD population. Logistic regression indicated 2 significant predictors for TTP: otitis media frequency and race. Furthermore, irritability rates in children approached predictive significance (β = 0.015, p < .10). Conclusions: The authors found that approximately 1 in 6 children with ASD underwent TTP, more than double the rate in the general population. The rate may simply be higher because physicians are swift to perform TTP in children at risk for speech delay. At this time, there exists a lack of data on the outcomes of TTP in children with ASD. More evidence is needed to understand the usefulness of TTP in children with ASD given the high rate of procedures being performed.