PubMed abstract / permitted excerpt

OBJECTIVE: To assess the impact of COVID-19 pandemic response on the incidence and severity of pediatric mastoiditis in the Australian context. STUDY DESIGN: Retrospective case series. SETTING: Single tertiary pediatric referral hospital in Australia. METHODS: Retrospective review of pediatric patients (<18 years) admitted with acute mastoiditis (AM) from January 2012 to June 2025 was performed. Patients were categorized into time periods: pre-COVID, COVID, and post-COVID based on Australian health policy timelines. Baseline demographic and admission data were collected. The primary outcomes were AM incidence per emergency department (ED) admissions, mastoiditis complications and disease severity, surgical intervention and microbial spectrum. A subanalysis comparing prerestriction and postrestriction population was performed. RESULTS: 176 patients were assessed. AM incidence per ED admissions sharply increased in the post-COVID era and exceeded pre-COVID levels. The proportion of patients with intracranial complications increased sharply over time. Mastoidectomy rates doubled from 13.43% (pre-COVID) to 28.40% (post-COVID). Streptococcus anginosus was associated with 100% mastoidectomy rate and very severe disease (80%). Patients in the postrestriction period had 3 times greater risk of very severe disease compared to prerestriction: 18.4% vs 6.0%, RR, 3.07 (95% CI, 1.1-8.6), P = .03. CONCLUSION: An alarming increase in incidence and severity of pediatric AM in the postpandemic Australian population was identified. Vigilance of intracranial complications and rapid escalation of therapy are strongly recommended.