(A932) Intracranial Complications Secondary to Acute Mastoiditis and Sinusitis in the Post-Covid Era: A Preliminary Report

Introduction: In the post-COVID era, we observed increased otologic and sinogenic infections with intracranial manifestations in the pediatric population. Similar increases have been suspected and described in recent literature at other institutions.

Methods: We identified pediatric patients who were admitted with intracranial infections, acute otitis media (AOM), mastoiditis, and sinusitis between May 1, 2013 and May 30, 2023. The COVID era was defined as March 11, 2020, through December 2, 2021. Patient demographics, need for intervention, and patient outcomes were reviewed in those with concurrent intracranial and otolaryngologic infection. Fisher’s exact test was used for analysis.

Results: 1565 pediatric patients were admitted with AOM, mastoiditis, or sinusitis during the time period. Of these patients, in-hospital mortality increased during the COVID era but has remained higher in the post-COVID period (pre-COVID 0.3%, COVID 1.16%, post-COVID 0.86%). In the COVID and post-COVID eras, there were also increases in intracranial complications in these patients including meningitis 3.3% vs. 10.4% vs. 5.3%, encephalitis 1.3% vs 3.4% vs 2.4%, brain abscess 2.4% vs 3.4% vs 3.6%, sigmoid sinus thrombosis 2.4% vs 2.3% vs 3.8%, and skull base osteomyelitis 0.56% vs 1.16% vs 1.56%). Patients requiring surgical intervention increased in the post-COVID era in otologic infections (tympanostomy tube placement 11.87% vs 13.32%, mastoidectomy 3.63% vs 5.19%, and sigmoid sinus decompression 0.22% vs 0.69%), but the rate of sinogenic intervention decreased (4.22% vs 3.63%).

Conclusions: In our single institution retrospective review, there were increased rates of otolaryngologic complications by intracranial infections in the COVID and post-COVID eras. Otologic surgical interventions increased, but sinogenic intervention decreased. Further multivariate analysis is ongoing to determine variables associated with this increase in complicated pediatric otolaryngology infections and to determine any differences in socioeconomic factors associated with these findings.