Acute paediatric mastoiditis in the UK before and during the COVID‐19 pandemic: A national observational study

Smith, Matthew; Jones, G. Huw; Hardman, John; Nichani, Jaya; Khwaja, Sadie; Bruce, Iain; Rea, Peter

doi:10.1111/coa.13869

Cited by 19 publications

(10 citation statements)

References 29 publications

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“…10 We predicted delayed, more severe presentations 17 and microbial alterations similar to other common infectious ENT conditions such as otitis media, and mastoiditis during this era. 9,11 Surprisingly, clinical features at presentation were not significantly different apart from increased CRP levels. In contrast to our findings, Callego et al's report on peritonsillar infections during the COVID 19 era in Spain reported more delayed, severe presentations and prolonged hospitalizations.…”

Section: Discussionmentioning

confidence: 88%

“…Prompt treatment is necessary, as PTA may give rise, albeit rarely, to life-threatening complications secondary to spread along fascial planes to the deep neck and chest. [6][7][8] The COVID-19 pandemic has been shown to impact the microbiology 9 and clinical course of several paediatric ENT infectious diseases, including otitis media, sinusitis, laryngitis and mastoiditis. [10][11][12] Acute mastoiditis demonstrated reductions in common pathogens such as Streptococcus pneumoniae and Haemophilus influenzae, with a concomitant increase in Pseudomonas cultivation during the COVID era.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID‐19 era on clinical presentation, management and microbiology in paediatric peritonsillar abscess: A case–control study

Heilig,

Sapir,

Yafit

et al. 2023

Clinical Otolaryngology

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ObjectivesPeritonsillar abscess (PTA) is the most common soft‐tissue infection of the head and neck. This potential complication of tonsillitis has demonstrated unique microbial trends during the COVID‐19 pandemic. This era has resulted in a major shift in the hygiene and social habits of the general population, which has resulted in changes in the presentation, management and microbiology of several infectious diseases. To date, the impact of COVID 19 on PTA microbiology and clinical presentation in the paediatric population has yet to be investigated.DesignRetrospective chart review comparing all cases of paediatric (age 0–18) PTA in an academic tertiary centre during the COVID‐19 pandemic (03/2020–02/2022) and compared them to two control groups: pre‐COVID (03/2018–02/2020) and post‐COVID (03/2022–03/2023). All patients were treated with either needle aspiration, incision and drainage or both means in addition to intravenous antibiotics.SettingA large Ear Nose and Throat department in a tertiary referral center.ParticipantsConsecutive children aged 18 years or under, admitted with a diagnosis of Peritonsillar abscess.Main Outcome MeasuresWe analyzed the clinical and microbiologcal features of all cases of pediatric peritonsillar abscess during the COVID‐19 era (03/2020‐02/2022) and compared them to a pre and post control cases.ResultsA total of 96 PTA cases were included (35 pre‐COVID, 35 COVID and 26 post‐COVID). The means of procedural treatment shifted in favour of incision and drainage versus needle aspiration during the COVID era. The length of hospitalisation increased during the COVID era (3.6 days vs. 2.1 and 3.1 pre and post‐COVID respectively, p < .001). No other notable differences in the clinical and demographic features were found between the three eras. The COVID‐19 era saw an increase in Fusobacterium (37.1% vs. 8.6% and 24% pre and post‐COVID, respectively; p = .008) and Streptococcus Anginosus (31.4% vs. 5.7% and 7.7% pre and post‐COVID, respectively; p = .007) species isolation.ConclusionsThe COVID‐19 pandemic did not seem to impact the clinical presentation of paediatric PTA yet resulted in a change in microbiological pathogens. The choice of I&D as a means to shorten hospital stay during the pandemic may have led to an actual increase in hospital stay, suggesting that NA may be the preferred management approach.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Impact of the COVID‐19 era on clinical presentation, management and microbiology in paediatric peritonsillar abscess: A case–control study

Heilig,

Sapir,

Yafit

et al. 2023

Clinical Otolaryngology

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“…In addition, a national UK observation study of acute paediatric mastoiditis during COVID‐19 showed only one positive patient (0.9%). 13 This suggests a low risk of otological complications from AOM in COVID‐19 patients.…”

Section: Discussionmentioning

confidence: 94%

Ten‐year prevalence of acute hospital ENT infections and the impact of COVID: A large population study

Mettias

Jenkins

Rea

2022

Clinical Otolaryngology

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Background Acute ear, nose and throat (ENT) infections were the commonest referrals from accident and emergency to ENT services. The referral rate changed dramatically with season, year, national outbreaks and during the COVID pandemic. Method Retrospective longitudinal study of the epidemiology of seven acute ENT infections in secondary care over 10 years. A mixed city and rural population of over 650 000 in central England was studied. The risk factors for each wave of infection during the surge of infection were sought. A statistical analysis of their significance was undertaken. This included analysis and correlation of group A‐beta haemolytic streptococcus (GABHS) in hospital and community. Seasonal variations, hospital admissions and the impact of the COVID were analysed. Results There were 16 883 reported cases of the seven index ENT infections during the 10‐year period. Great seasonal and year‐to‐year variations were recorded. There was an incremental rise in 2018. Spring had the highest season of acute ENT infections. An outbreak of GABHS was noted in the community in 2014. The mean duration of hospital admission was 1.5 days. There was no statistical ethnic or gender predominance. A dramatically lower number of acute ENT infections were recorded during the COVID‐19 pandemic, and this continued after lifting of lockdown restrictions. Conclusion A resurgence in scarlet fever directly and indirectly contributed to an incremental rise in acute ENT infections in the following years. Both hospital and community B‐haemolytic cultures have declined during the COVID‐19 pandemic due to a reduction in infections as opposed to reduced case ascertainment.

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“…24,25 However, if indeed the avoidance of medical counseling was the main factor, one would expect a substantial parallel decrease in UTI burden as well, which was not the case; (4) The higher rate of complications during the first COVID year, especially acute mastoiditis (0.5% vs. 0.3% in pre-COVID years, P < 0.001), does not coincide with recent UK data. 26 This could be explained by a decrease in the total AOM episodes, therefore not reflecting a truly increased incidence of acute mastoiditis. Another explanation can be attributed to a higher threshold of seeking medical care during the first COVID period, leading to a selection bias.…”

Section: Discussionmentioning

confidence: 99%

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel

Zloczower

Pitaro

Hazan

et al. 2022

Pediatric Infectious Disease Journal

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Background: To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. Methods: This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017–February 29, 2020) and the first two COVID years (March 1, 2020–February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel’s largest healthcare maintenance organization. Children 0–15 years with AOM and UTI episodes were categorized according to age (1>, 1–4, 5–15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). Results: We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1–4.1). Male predominance, age at presentation, and the dominant age group of 1–4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68–0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34–0.63, P < 0.001). The largest decrease was observed among children 1–4 years old during the first COVID year (β=−1,938 AOM episodes/100,00 children, 95% CI, −2,038 to −1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05–0.05, P < 0.001). Conclusions: AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.

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Acute paediatric mastoiditis in the UK before and during the COVID‐19 pandemic: A national observational study

Cited by 19 publications

References 29 publications

Impact of the COVID‐19 era on clinical presentation, management and microbiology in paediatric peritonsillar abscess: A case–control study

Impact of the COVID‐19 era on clinical presentation, management and microbiology in paediatric peritonsillar abscess: A case–control study

Ten‐year prevalence of acute hospital ENT infections and the impact of COVID: A large population study

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel

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