Complicated acute rhinosinusitis in the pediatric population and the influence of COVID-19

Introduction and Objectives: Complications of acute rhinosinusitis (ARS) are more common in children and are divided, in decreasing order of frequency, into orbital, intracranial, and bony. The aim is to analyze the impact of SARS-CoV-2 on complicated ARS at a tertiary children’s hospital. Methods: A retrospective, observational study of a five-year period, categorized based on the SARS-CoV-2 pandemic into pre-COVID-19 (2018/2019), COVID-19 (2020/2021), and post-COVID-19 (2022). We included patients up to 18 years of age, who were admitted to the otorhinolaryngology (ENT) ward with ARS. Socio-demographic and clinical data were collected and analyzed. Results: Thirty-four children were admitted to our hospital with ARS. The incidence decreased during the COVID-19 period (N = 5) and increased in the post-COVID-19 period (N = 12). The mean Lund-Mackay score was 12.9, with no significant difference between periods. The rate of complications was 73.5% for orbital, 8.8% for intracranial, and 8.8% for bone complications. Orbital complications were more frequent in younger patients, while intracranial complications occurred more often in older children (p < 0.05). There were no intracranial complications in the pre-COVID-19 period and 66.7% of these occurred in the COVID-19 period. The leukocyte count and C-reactive protein (CRP) levels were higher in the nine patients requiring surgical treatment (p < 0.013 and p < 0.014), with the majority (55.6%) occurring in the post-COVID-19 period. Discussion: Consistent with other studies, we report an increase in severe infections since the COVID-19 pandemic. This increase could be related to the immunological impact of the social distancing measures implemented during the various lockdowns in our country throughout the first year of the SARS-CoV-2 pandemic.