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Acute mastoiditis: A 10-year retrospective study at a tertiary care center
Michal Bartos1, Milan Urik1, Vit Kruntorad1
1Department of Pediatric Otorhinolaryngology, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Insights
The COVID-19 pandemic increased acute mastoiditis (AM) incidence and severity in children, leading to more surgeries. Streptococcus pneumoniae was a common pathogen, highlighting the need for vigilant monitoring and early intervention.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases Epidemiology
Background:
- Acute mastoiditis (AM) is a severe complication of acute otitis media (AOM) in children.
- Evidence suggests the COVID-19 pandemic may have altered AM's epidemiology and severity.
Purpose of the Study:
- To analyze changes in pediatric acute mastoiditis (AM) incidence, severity, and management.
- To compare AM cases pre- and post-COVID-19 pandemic.
Main Methods:
- Retrospective cohort study of pediatric patients (0-18 years) diagnosed with AM from 2015-2024.
- Analysis of demographic data, clinical presentation, imaging, surgical interventions, complications, bacteriology, and antimicrobial therapy.
- Comparison of outcomes between pre-COVID (2015-2019) and pandemic/post-COVID (2020-2024) periods.
Main Results:
- AM cases increased post-pandemic (41 vs. 64).
- Higher rates of HRCT use and mastoidectomy (AMTs) were observed during the pandemic/post-COVID period (24 vs. 38).
- Intra- and extracranial complications rose significantly (2 vs. 10), with increased isolation of Streptococcus pneumoniae.
Conclusions:
- The pandemic/post-COVID era saw increased pediatric AM incidence and severity, necessitating more surgical interventions.
- Elevated pneumococcal infections and reduced prehospital antibiotic use may contribute to advanced disease.
- Ongoing surveillance of pathogens and prompt management are crucial for reducing AM complications.
Objective:
Acute mastoiditis (AM) is a serious complication of acute otitis media (AOM) and remains an important cause of pediatric morbidity. Recent evidence suggests shifts in the epidemiology and severity of AM following the COVID-19 pandemic.
Study Design:
Retrospective cohort study.
Setting:
Tertiary referral center.
Methods:
Pediatric patients (0-18 years) diagnosed with AM between 2015 and 2024 were retrospectively reviewed. Demographic characteristics, clinical presentation, imaging methods, surgical interventions, complications, bacteriological findings, and antimicrobial therapy were analyzed. Outcomes were compared between the pre-COVID (2015-2019) and pandemic/post-COVID (2020-2024) periods.
Results:
A total of 105 children (55 male) with a median age of 4 years met diagnostic criteria for AM. The number of AM cases increased from 41 in the pre-COVID period to 64 in the pandemic/post-COVID period. Use of HRCT increased substantially, and 62 AMTs were performed overall, more frequently during the pandemic/post-COVID period (24 vs. 38). Intra- and extracranial complications were more common in the pandemic/post-COVID period (2 vs. 10). Bacterial cultures were positive in 50.6% of cases, with Streptococcus pneumoniae identified as the predominant pathogen and more commonly isolated in pandemic/post-COVID patients undergoing AMT. Antimicrobial resistance was observed in 12.5% of positive cultures.
Conclusion:
The pandemic/post-COVID period was associated with increased incidence and severity of pediatric AM and therefore a greater need for surgical intervention. Increased pneumococcal involvement and low prehospital antimicrobial use may have contributed to more advanced disease presentation. Continued monitoring of pathogen trends and early management strategies remain essential for reducing complications and optimizing care.
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