Increase in acute mastoiditis at the end of the COVID-19 pandemic

Eva Goldberg-Bockhorn; Clara Hurzlmeier; Julius M Vahl; Franziska Stupp; Aleš Janda; Heike von Baum; Thomas K Hoffmann

doi:10.1007/s00405-024-08704-y

Increase in acute mastoiditis at the end of the COVID-19 pandemic

Eur Arch Otorhinolaryngol. 2024 May 14. doi: 10.1007/s00405-024-08704-y. Online ahead of print.

Authors

Eva Goldberg-Bockhorn¹, Clara Hurzlmeier², Julius M Vahl², Franziska Stupp², Aleš Janda³, Heike von Baum⁴, Thomas K Hoffmann²

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany. eva.goldberg@uniklinik-ulm.de.
² Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
³ Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Eythstraße 24, 89075, Ulm, Germany.
⁴ Institute of Medical Microbiology and Hospital Hygiene, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.

PMID: 38740579
DOI: 10.1007/s00405-024-08704-y

Abstract

Purpose: Common respiratory infections were significantly reduced during the COVID-19 pandemic due to general protective and hygiene measures. The gradual withdrawal of these non-pharmaceutical interventions (NPI) was associated with a notable increase in these infections, particularly in pediatric and adult otorhinolaryngology. The aim of this retrospective monocentric study was to evaluate the impact of NPI during the COVID-19 pandemic on the incidence and severity of acute mastoiditis (AM).

Methods: Pre-pandemic clinical data of AM cases from 2011 to 2019 were compared with infection counts from January 2020 to June 2023 for seasonal periodicity, age-specific differences, pathogens, and complication rates in a German third-level hospital.

Results: Out of 196 patients with AM 133 were children, the majority between 1 and 5 years of age. Complications of AM, such as meningitis, brain abscess, and sinus vein thrombosis, were more common in adults (87%) than in children (17%). Morbidity and mortality rates were similar before, during and after the pandemic. Pneumococci were the most common pathogen in both age groups, with a post-pandemic cumulation of Streptococcus pyogenes infections in children. While pre-pandemic cases clustered in spring, seasonality was absent in all age groups during the main phase of the pandemic. The cessation of NPI caused a steep rise in AM cases in both age groups starting from December 2022.

Conclusion: NPI during the COVID-19 pandemic reduced the incidence of AM. Their reversal led to a substantial increase in the incidence of AM during the post-pandemic period, which may be due to a general increase in viral respiratory infections and an insufficiently trained immune system.

Keywords: Acute mastoiditis; Acute otitis media; COVID-19; Complications; GAS; Pneumococcal infection.