Impact of the COVID-19 pandemic on the incidence of acute mastoiditis in a tertiary reference children’s hospital in Brazil

Neves, Hemily Izabel Alves; Lavinsky, Joel; Margheti, Luana Vieira; Miura, Mauricio Schneider; Ogando, Patrícia Barcelos; Rocha Filho, Marcelo Assis Moro da; Lubianca Neto, Jose Faibes

doi:10.1016/j.jped.2025.05.003

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Original article • J. Pediatr. (Rio J.) 101 (5) • 2025 • https://doi.org/10.1016/j.jped.2025.05.003 linkcopy

Impact of the COVID-19 pandemic on the incidence of acute mastoiditis in a tertiary reference children’s hospital in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives To compare the incidence of AM hospitalizations and complications across three periods: pre-pandemic, pandemic, and post-pandemic. Additionally, the study aims to evaluate associations with patient age, need for surgical intervention, antibiotic therapy, and isolated etiological agents.

Methods This retrospective cohort study reviewed pediatric charts from three 22-month periods: pre-pandemic (P1), pandemic (P2), and post-pandemic (P3). These periods were compared in terms of case numbers, presence and severity of AM complications, patient demographics (age and sex), and treatment approaches.

Results A total of 9 AM cases were recorded in (P1), 5 in the (P2), and 25 in (P3). This represents a 25.5 % reduction in AM incidence during the pandemic compared to the pre-pandemic period, though this was not statistically significant (p = 0.8027). However, a significant 103.3 % increase in AM incidence was noted between the pre- and post-pandemic periods (p = 0.0322). No significant differences were found among periods regarding age, sex, complications, case severity, surgical intervention, antibiotic duration, or length of hospitalization.

Conclusion Although AM incidence slightly declined during the pandemic, the post-pandemic period showed a significant rise in the incidence of cases compared to pre-pandemic values.

Keywords
Mastoiditis; Acute otitis media; Covid-19; Otology; Pediatric otolaryngology

a) Incidence of acute mastoiditis per 100,000 hospitalizations in children aged 0-14 years. Kruskal-Wallis test across periods; Mann-Whitney tests for pairwise comparisons (P1 vs. P2 and P1 vs. P3).
	Cases	Hospitalizations	Incidence (per 100,000 inhab.)	SD	SE	95 % CI	Kruskal-Wallis p-value	Relative to P1	Mann-Whitney p-value
P1	9	13,435	67	7.139	1.522	23.23ー110.74	0.0137	-
P2	5	10,022	49.90	5.273	1.124	6.17ー93.61		↓ 25.5 %	0.8027
P3	25	18,351	136.2	7.576	1.615	82.86ー189.59		↑ 103.3 %	0.0322
Total	39	41,808	93.2

b) Monthly average of AM cases per 100,000 hospitalizations in children aged 0-14 years. Kruskal-Wallis test across periods; Mann-Whitney tests for pairwise comparisons (P1 vs. P2 and P1 vs. P3).
	Cases	Hospitalizations	Monthly average	SD	SE	95 % CI	Kruskal-Wallis p-value	Relative to P1	Mann-Whitney p-value
P1	9	13,435	0.41	0.9591	0.2045	0.0083ー0.8099	0.0042	-
P2	5	10,022	0.22	0.5284	0.1127	0.0065ー0.4481		↓ 46.34 %	0.6764
P3	25	18,351	1.13	1.3903	0.2964	0.5554ー1.7173		↑ 175.61 %	0.0146
Total	39	41,808	0.84

	Median [IQR]				Media
	Overall	P1	P2	P3	Overall	P1	P2	P3	p-value
Age (Months)	38 [20; 55]	33 [23; 40]	19 [14; 44]	41 [27; 55]	40 ± 22,4	36.4 ± 19.5	34.6 ± 31	42.4 ± 22.1	0.582
Total duration of antibiotic therapy (days)	25 [20; 35]	23 [22; 42]	20 [19; 21]	28 [20; 35]	12.5 ± 9.6	11.2 ± 8.3	9.8 ± 5.6	13.5 ± 10.7	0.202
Total length of hospital stay (days)	9 [7; 15]	7 [6; 14]	8 [8; 10]	9 [8; 15]	27.5 ± 9.9	29 ± 12.4	20.6 ± 4	28.4 ± 9.5	0.587

		Overall		P1		P2		P3
		n	%	n	%	n	%	n	%	p-value
Age range	≤12 months	4	10.3 %	1	11.1 %	1	20.0 %	2	8.0 %	0.786
	13-24 months	8	20.5 %	2	22.2 %	2	40.0 %	4	16.0 %
	25-60 months	20	51.3 %	5	55.6 %	1	20.0 %	14	56.0 %
	>60 months	7	17.9 %	1	11.1 %	1	20.0 %	5	20.0 %
Males		21	53.8 %	6	66.7 %	3	60.0 %	12	48.0 %	0.602
Home antibiotics (any)		30	76.9 %	8	88.9 %	3	60.0 %	19	76.0 %	0.462
Complications	Any	32	82.1 %	8	88.9 %	3	60.0 %	21	84.0 %	0.368
	Epidural abscess	4	10.3 %	2	22.2 %	0	0.0 %	2	8.0 %	0.348
	Subperiosteal abscess	29	74.4 %	8	88.9 %	3	60.0 %	18	72.0 %	0.447
	Bezold's abscess	2	5.1 %	0	0.0 %	1	20.0 %	1	4.0 %	0.244
	Central venous thrombosis	4	10.3 %	0	0.0 %	0	0.0 %	4	16.0 %	0.287
	Cranial nerve palsy	2	5.1 %	0	0.0 %	0	0.0 %	2	8.0 %	0.554
	CNS complications	8	20.5 %	2	22.2 %	0	0.0 %	6	24.0 %	0.474
	Major complications	9	23.1 %	2	22.2 %	1	20.0 %	6	24.0 %	0.979
Surgical intervention	Any surgery	34	87.2 %	9	100 %	4	80.0 %	21	84.0 %	0.411
	Tube tympanostomy	29	74.4 %	7	77.8 %	4	80.0 %	18	72.0 %	0.778
	Mastoidectomy	11	28.2 %	3	33.3 %	1	20.0 %	7	28.0 %	0.900
	Subperiosteal abscess drainage	19	48.7 %	4	44.4 %	2	40.0 %	13	52.0 %	0.850
	Epidural abscess drainage	1	2.6 %	1	11.1 %	0	0.0 %	0	0.0 %	0.181

		Total	Complications		p-value	CNS complications		p-value	Major complications
		n	n	%	p-value	n	%	p-value	n	%	p-value
Age range	≤12 months	4	2	50.0 %	0.226	0	0.0 %	0.214	0	0.0 %	0.128
	13-24 months	8	7	87.5 %		0	0.0 %		0	0.0 %
	25-60 months	20	18	90.0 %		6	30.0 %		6	30.0 %
	> 60 months	7	5	71.4 %		2	28.6 %		3	42.9 %
Sex	M	21	18	85.7 %	0.682	5	23.8 %	0.702	6	28.6 %	0.464
Sex	F	18	14	77.8 %	0.682	3	16.7 %	0.702	3	16.7 %	0.464
Home antibiotics	Y	30	24	80.0 %	1.000	6	20.0 %	1.000	6	20.0 %	0.406
Home antibiotics	N	9	8	88.9 %	1.000	2	22.2 %	1.000	3	33.3 %	0.406

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