Trends in Complications of Pediatric Rhinosinusitis Before and During the COVID-19 Era

Objective: To examine changes in trends of the incidence and characteristics of pediatric complicated rhinosinusitis with respect to the coronavirus disease 2019 (COVID-19) pandemic. Study Design: Retrospective cohort. Setting: Single tertiary-care center. Methods: A review of patients who presented to St. Louis Children's Hospital (SLCH) with complicated rhinosinusitis from 2017 to 2022 was performed. Clinical and follow-up data were analyzed in association with COVID-19. Results: Eighty-three patients with complicated rhinosinusitis were identified and analyzed according to hospitalization before or after March 2020. No differences in demographic variables were found between the two groups. More patients had developmental comorbidities in the COVID-19 group (7 vs 1, P =.049). More patients with intracranial complications (55% vs 45%, P =.48) and Pott's puffy tumor (78% vs 22%, P =.13) were observed in the COVID-19 era group; however, this difference was not statistically significant. In the COVID-19 group, more patients were found to have Streptococcus anginosus growth in their surgical cultures (67% vs 33%, P =.03). The incidence of complicated sinusitis correlated with the incidence of all viral cases at SLCH, particularly in 2021 and 2022, and increased following COVID-19. Conclusion: Trends in complicated sinusitis vary before and after the onset of the COVID-19 pandemic. There was an increase in complications of sinusitis due to S. anginosus species in the COVID-19 era and trends towards increased intracranial complications and Pott's puffy tumor. After an initial decrease, the incidence of complicated sinusitis per year increased following COVID-19.