Acute appendicitis in children during the COVID-19 pandemic

Abstract

Introduction. Ear complications in children are rare and are still an immediate life threatening condition. In children the most common complication is acute mastoiditis in the course of acute otitis media. The predominant symptoms are severe pain in the ear and the retroauricular region, swelling of the muzzle region with protrusion of the auricle and subsidence of the posteriori-top wall of the external auditory canal. Aim. The aim of this study was to present patients with acute mastoiditis during the COVID-19 pandemic and to evaluate the co-infection with SARS-CoV-2 virus. Material and methods. A retrospective analysis of hospitalized patients with acute mastoiditis between 2020 and 2021 was performed. We evaluated the co-occurrence of SARS-CoV-2 infection in children with ear complications, seasonality of complications, age, gender, diagnostic methods and analysis of pathogens responsible for the development of the complication. Results. Between 2020 and 2021, 23 patients with acute mastoiditis were hospitalized at the Department of Pediatric Otolaryngology University Clinical Center Medical University of Warsaw. One patient was diagnosed with coexisting SARS-CoV-2 infection. In the analyzed group there was a significant predominance of boys over girls M:K = 2.8:1. The mean age of the patients was 5 years. All patients showed clinical signs of acute mastoiditis in the form of swelling of the soft tissues of the behind-the-ear region with inflammation of the skin and withdrawal of the auricle. Otoscopic examination revealed purulent middle ear leakage in 22% of children, while the remaining 78% showed no perforation of the tympanic membrane, with purulent discharge deposited throughout the tympanic cavity. In the bacteriological studies obtained, no pathogens were found in 74% of the children. All patients had intravenous antibiotic therapy and surgical treatment. Conclusions. Among hospitalized patients with acute mastoiditis, the highest morbidity was observed in January-April 2020 and September-December 2021. No patient with ear complication was hospitalized from May 2020 to September 2020. This was the period when, from May 2020, day nurseries, kindergartens and schools began to be subject to strict sanitary regime recommendations by the Chief Sanitary Inspectorate, which could contribute to a reduced incidence of upper respiratory tract infections. Hospitalization of a patient with acute mastoiditis with a coexisting complication of SARS-CoV-2 infection required isolation of the patient in the observation-isolation unit of our hospital. However, the patient’s respiratory and circulatory distress wasn’t observed and he didn’t require intensive medical care.