Epidemiological and Clinical Changes in Pediatric Acute Mastoiditis Before and After the COVID-19 Pandemic: An Eight-Year Retrospective Study from a Tertiary-Level Center

<b>Background</b>: Acute mastoiditis is the most frequent suppurative complication of acute otitis media in children. AM can lead to both extracranial complications and intracranial complications. Recent studies suggest an increase in cases after the COVID-19 pandemic. <b>Objective</b>: To compare the epidemiological and clinical characteristics of pediatric patients diagnosed with acute mastoiditis admitted to Santobono-Pausilipon Children's Hospital before and after COVID-19. <b>Methods</b>: We conducted a retrospective study including all patients aged 0-16 years with AM admitted to our hospital between January 2017 and December 2024. Patients were stratified into three groups: pre-COVID-19: 1 January 2017-28 February 2020; COVID-19: 1 March 2020-31 December 2021; and post-COVID-19: 1 January 2022-31 December 2024. Demographic data, clinical presentations, complications, laboratory findings, and treatment modalities were analyzed and compared between groups. <b>Results</b>: A total of 276 children (153 males and 123 females; median age: 49 months, age range: 1-177 months) were included. Hospital admissions for AM increased in the post-COVID-19 period, reaching more than a threefold increase in 2024 compared with the pre-COVID-19 years. Similar to the overall number of AM cases, the absolute number of complications, especially IC, such as thrombosis and empyema, increased. The rate of surgical procedures increased during the post-COVID-19 period, with an overall increase of 88.5%. Both the duration of antibiotic therapy and hospital stay were significantly longer in the post-COVID-19 period. <b>Conclusions</b>: The COVID-19 pandemic has been associated with epidemiological and clinical changes in pediatric AM patients. These findings highlight the need for effective preventive strategies, including enhanced vaccination coverage and the promotion of early diagnosis. Additionally, implementing standardized clinical protocols could support more efficient and consistent management, reducing hospital stays and recurrence rates.