Acute mastoiditis: A 10-year retrospective study at a tertiary care center

Acute mastoiditis (AM) is a serious complication of acute otitis media (AOM) and remains an important cause of pediatric morbidity. Recent evidence suggests shifts in the epidemiology and severity of AM following the COVID-19 pandemic.

Retrospective cohort study.

Tertiary referral center.

Pediatric patients (0-18 years) diagnosed with AM between 2015 and 2024 were retrospectively reviewed. Demographic characteristics, clinical presentation, imaging methods, surgical interventions, complications, bacteriological findings, and antimicrobial therapy were analyzed. Outcomes were compared between the pre-COVID (2015-2019) and pandemic/post-COVID (2020-2024) periods.

A total of 105 children (55 male) with a median age of 4 years met diagnostic criteria for AM. The number of AM cases increased from 41 in the pre-COVID period to 64 in the pandemic/post-COVID period. Use of HRCT increased substantially, and 62 AMTs were performed overall, more frequently during the pandemic/post-COVID period (24 vs. 38). Intra- and extracranial complications were more common in the pandemic/post-COVID period (2 vs. 10). Bacterial cultures were positive in 50.6% of cases, with Streptococcus pneumoniae identified as the predominant pathogen and more commonly isolated in pandemic/post-COVID patients undergoing AMT. Antimicrobial resistance was observed in 12.5% of positive cultures.

The pandemic/post-COVID period was associated with increased incidence and severity of pediatric AM and therefore a greater need for surgical intervention. Increased pneumococcal involvement and low prehospital antimicrobial use may have contributed to more advanced disease presentation. Continued monitoring of pathogen trends and early management strategies remain essential for reducing complications and optimizing care.