Acute Pediatric Mastoiditis Numbers and Related Complications Before During and After the COVID-19 Pandemic

Objective: To evaluate acute pediatric mastoiditis numbers and associated complications before, during, and after the COVID-19 pandemic. Methods: A retrospective chart review of all children less than 18 years of age presenting to a pediatric tertiary medical center with acute mastoiditis from January 1, 2017 to October 30, 2023 was completed. Exclusion criteria included history of chronic mastoiditis, cholesteatoma and mastoidectomy. Demographic and clinical data were collected and included age, sex, race, ethnicity, duration between onset of symptoms and presentation, white blood cell count and C-reactive protein level, affected ear, intracranial and extracranial complications, procedures, readmission and reoperation, length of hospital stay, and culture results. Patients were classified in relation to the COVID pandemic into three groups: pre-COVID included patients presenting from January 1, 2017, until December 31, 2019, COVID from January 1, 2020, until December 31, 2021, and post-COVID from January 1, 2022, until October 30, 2023. Results: A total of 89 patients, 49 males and 40 females, with a mean age of 53.8 f 40.7 months were included. Twenty-four (27.0 %) patients presented in the pre-COVID, 14 (15.7 %) in the COVID, and 51 (57.3 %) in the post-COVID period. There was no difference in the mean duration between onset of symptoms and presentation across the groups (5.4 f 4.4 days pre-COVID, 5.8 f 6.8 days during COVID, and 8.5 f 8.1 post-COVID, P = 0.16). The post-COVID mean annual number of mastoiditis cases (27.8 cases/year) was higher compared to preCOVID (8 cases/year) and COVID (7 cases/year). Similarly, the post-COVID mean annual number of cases with complications (24 cases/year) was higher compared to pre-COVID (5 cases/year) and COVID (5.5 cases/year). Of note, the post-COVID mean annual number of cases with intracranial complications (12cases/year) was also higher compared to pre-COVID (1.3cases/year) and COVID (1.5cases/year). There was no difference in the number of cases requiring operation across cohorts (97.8 % overall, p = 0.07). Conclusion: This study revealed a 3.5-fold increase in the mean annual number of mastoiditis cases and a 4.8-fold increase in the mean annual number of cases with complications post-COVID compared to pre-COVID.