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Epidemiological evolution of acute mastoiditis in children after COVID-19 pandemic

Barbara Ribaut1, Sonia Ayari-Khalfallah2, Eric Truy3,4

  • 1Department of Pediatric Otolaryngology-Head and Neck Surgery, Femme Mere Enfant Hospital-Hospices Civils de Lyon, Lyon, France. barbara.ribaut@gmail.com.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
|July 23, 2025
PubMed
Abstract

Insights

Acute mastoiditis (AM) cases increased post-COVID, with Streptococcus pyogenes becoming more common. Complication rates stayed similar, but older age and prior antibiotic use were risk factors for severe AM.

Area of Science:

  • Pediatric infectious diseases
  • Otolaryngology
  • Epidemiology

Background:

  • Acute mastoiditis (AM) is a common complication of acute otitis media in children, with potential for severe intracranial issues.
  • The COVID-19 pandemic has been associated with shifts in AM epidemiology, including increased incidence, altered seasonality, and changes in causative bacteria.

Purpose of the Study:

  • To evaluate the incidence of acute and complicated mastoiditis before and after the COVID-19 pandemic.
  • To assess changes in clinical outcomes and bacterial profiles of AM cases.
  • To identify risk factors associated with AM complications.

Main Methods:

  • A retrospective cohort study of children under 18 diagnosed with AM between March 2018 and March 2024.
  • Cases were divided into pre- and post-COVID periods for comparative analysis.
  • Clinical, demographic, treatment, and outcome data were collected, with AM classified as simple or complicated based on criteria.

Main Results:

  • AM incidence rose significantly post-COVID (31 to 105 cases), while complication rates remained stable (32.3% pre- vs. 24.8% post-COVID).
  • Streptococcus pyogenes prevalence increased (9.7% to 34.6%), while Streptococcus pneumoniae decreased (32.3% to 11.5%).
  • Older age, elevated CRP, and prehospital antibiotic use were risk factors for complications; complicated cases peaked in spring.

Conclusions:

  • AM incidence has increased following the COVID-19 pandemic, with Streptococcus pyogenes emerging as the predominant pathogen.
  • Complication rates for AM have not significantly changed, but specific risk factors like older age and prior antibiotic exposure persist.
  • Ongoing surveillance and adaptive management strategies are essential for addressing evolving AM epidemiology.
Keywords:
Acute mastoiditisIntracranial complicationsPost-COVID epidemiologyRisk factorsStreptococcus pyogenes

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