Objectives To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. Design National retrospective and prospective audit Setting 48 UK secondary care ENT departments Participants Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis. Main outcome measures Cases were divided into: Period 1 (01/11/19-15/03/20) before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1&2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical). Results 286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in Dec 2020-Feb 2021. Patient age differed between period 1&2 (3.2 Vs 4.7 years respectively, p<0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% Vs 24.3%, p=0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2. Conclusion The COVID-19 pandemic led to a significant change in the presentation and case-mix of acute paediatric mastoiditis in the UK.

Objectives Otorhinolaryngology trainees in the United Kingdom are required to perform ten septorhinoplasty procedures as the main operating surgeon in order to achieve a certificate of completion of training (CCT). The COVID-19 pandemic has profoundly reduced operative opportunities for surgical trainees around the world. Our aim was to assess UK otorhinolaryngology trainees’ perceptions of their septorhinoplasty training in the pre-COVID-19 era and frame this within the current training environment brought about by the COVID-19 pandemic. Design Cross-sectional survey. Setting United Kingdom. Participants UK otorhinolaryngology trainees. Main outcome measures Information on trainees’ previous operative experience, courses attended, learning materials used and challenges faced gaining septorhinoplasty training was collected. Results 64 trainees responded. All Deaneries and Local Education and Training Boards were represented. 63/64 (98.4%) trainees had operative exposure septorhinoplasty. 60/64 (93.8%) trainees were currently at a trust where septorhinoplasty was performed. A variety of challenges regarding septorhinoplasty training were highlighted, the most common problem being the low number of cases being performed. Nearly one-third (8/25) of ST7-8 trainees in this sample had still not yet performed a septorhinoplasty on at least one occasion even though they were into the final third of their training. Conclusions The COVID-19 pandemic is a new and additional threat to septorhinoplasty training for otorhinolaryngology trainees, particularly those in the final third of the programme. In the short term, clarification is required on what level of operative proficiency is required for a CCT. Longer-term, threats to training can be mitigated by providing cadaveric courses, embracing simulation and considering private sector placements in areas of low NHS volume.