# Examining Tympanostomy Tube Risk by Breastfeeding Duration: Is Six Months Enough?

## TL;DR

Breastfeeding for six months reduces the risk of needing ear tubes in children, but longer breastfeeding does not offer extra protection.

## Contribution

This study provides empirical evidence on the protective effect of breastfeeding duration against tympanostomy tube placement.

## Key findings

- Children breastfed for six months had a 28% lower risk of ear tube insertion compared to those breastfed less than six months.
- Breastfeeding beyond six months did not significantly reduce the risk further.
- Formula-fed infants had the highest rate of tympanostomy tube insertion.

## Abstract

Background: Breastfeeding provides passive immunoglobulin A (IgA) immunity to newborns, supporting proper sinonasal, pulmonary, and mucosal protection. Current recommendations advise breastfeeding for at least six months before introducing complementary foods, with continuation encouraged for up to two years. Infants who are not breastfed are at increased risk for sinopulmonary infections, including acute otitis media. Recurrent or chronic acute otitis media can lead to tympanostomy tube placement. While this highlights the protective role of breastfeeding, there is limited data on whether extending breastfeeding beyond six months offers additional protection against the need for tympanostomy tube insertion.

Objective: This study aimed to evaluate whether longer durations of breastfeeding provide additional protection against tympanostomy tube placement in pediatric patients.

Methods: A retrospective chart review was conducted to evaluate pediatric patients who underwent tympanostomy tube placement using Current Procedural Terminology (CPT) codes 69436 and 69433 and a control group matched by age and gender. Feeding type was classified as formula-fed or breastfed, with breastfeeding duration recorded to the best of available documentation. Children who received both breast milk and formula were considered breastfed. Chi-squared tests and risk ratios were used to analyze the association between breastfeeding duration and tympanostomy tube placement.

Results: Among 500 pediatric patients, breastfeeding duration was significantly associated with tympanostomy tube insertion (χ²=9.36; p=0.025). Children breastfed for less than six months or not at all had a tube insertion rate of 20.8% (reference). Those breastfed for six months had a rate of 11.6% (RR: 0.72; p=0.025). Children breastfed for more than six months had a rate of 8.4% (RR: 0.79; p=0.08). Those breastfed for more than 12 months had a rate of 9% (RR: 0.95; p=0.08). Pairwise comparisons between children breastfed for six months and those breastfed for more than six months (χ²=0.24; p=0.63) or more than 12 months (χ²=2.99; p=0.084) were not statistically significant.

Conclusion: Breastfeeding for up to six months is associated with a lower risk of tympanostomy tube insertion compared to children breastfed for shorter than six months or not breastfed at all. Continuing breastfeeding beyond six months and 12 months does not appear to provide additional protective benefit.