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Acute mastoiditis in children during the Covid era: A systematic review and meta-analysis

Erin E Briggs1, Isabelle J Chau2, Shaun A Nguyen3

  • 1Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC, 29425, USA; Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.

International Journal of Pediatric Otorhinolaryngology
|October 24, 2025
PubMed

Insights

The COVID-19 pandemic increased intracranial complications in pediatric acute mastoiditis (AM). Fewer AM cases were treated with antibiotics alone, and bacterial patterns shifted, requiring new management strategies.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Pediatric Health

Background:

  • Pediatric acute mastoiditis (AM) is a significant concern.
  • The COVID-19 pandemic may have influenced AM presentation and management.
  • Understanding these changes is crucial for optimal pediatric care.

Purpose of the Study:

  • To investigate the impact of the COVID-19 pandemic on pediatric acute mastoiditis.
  • To analyze changes in clinical presentation, bacterial epidemiology, complications, and management of AM during the pandemic.

Main Methods:

  • A systematic literature search was conducted across major databases (CINAHL, Cochrane Library, PubMed, Scopus).
  • Studies published between 2014 and 2025 reporting on pediatric AM were included.
  • Outcomes assessed included clinical presentation, bacterial epidemiology, complications, and treatment, with statistical analysis of proportions and risks.

Main Results:

  • Seven studies (N=1001 children) were analyzed, comparing pre-COVID and COVID-era cohorts.
  • A significant increase in intracranial complications was observed post-pandemic (RR: 1.2).
  • Conservative antibiotic treatment decreased significantly (mean difference 10.8%), and bacterial epidemiology shifted.

Conclusions:

  • The COVID-19 pandemic is associated with increased intracranial complications in pediatric AM.
  • Fewer cases are managed solely with antibiotics, and bacterial patterns have changed.
  • Further research is needed to adapt AM management strategies in the post-pandemic era.
Abstract

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