Introduction: Acute Mastoiditis (AM) is a relatively rare complication arising from acute otitis media, a common condition among children. The COVID-19 pandemic has significantly impacted AM cases. We noted a surge in pediatric AM cases in Germany after COVID-19 restrictions were lifted in 2022. This study assesses AM incidence and the clinical course in children before, during and after the pandemic.

Methods:We included children (0-18 years) diagnosed with AM who underwent mastoidectomy at the LMU University Hospital of Munich. We aimed to evaluate AM incidence during pre-COVID, COVID, and post-COVID periods, assessed complications, and analysed the microbial spectrum. This data was collected over a duration spanning from January 2012 to June 2023, by scanning the hospital software for children who were assigned with the OPS-Code 5.203.0/71 following a clinical diagnosis of acute mastoiditis.

Results: 5 children were included. Significant increases in AM cases occurred in the post-COVID period compared to pre-COVID and COVID periods (3.34 cases vs. 0.39 cases vs. 0.20 cases per month; p < 0.05). Complication rates increased notably in the post-COVID period compared to pre-COVID and COVID periods (1.00 cases vs. 0.07 cases vs. 0 cases per month; p < 0.05). No significant differences were found in pathogen distribution between periods. Pre-Covid Preoperative CT scans were performed without contrast medium. Post-COVID correlating to an increasing number of intracranial complication CT scans with contrast medium became more frequent.

Discussion: The study highlights a substantial rise in AM cases and complications post-COVID-19 restrictions in Germany. Additionally, the study highlights the importance of contrast-enhanced imaging in addition to promt surgical therapy.

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