{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:27:08Z","timestamp":1786969628438,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of COVID\u201019 pandemic response on the incidence and severity of pediatric mastoiditis in the Australian context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single tertiary pediatric referral hospital in Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of pediatric patients (&lt;18 years) admitted with acute mastoiditis (AM) from January 2012 to June 2025 was performed. Patients were categorized into time periods: pre\u2010COVID, COVID, and post\u2010COVID 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      176 patients were assessed. AM incidence per ED admissions sharply increased in the post\u2010COVID era and exceeded pre\u2010COVID levels. The proportion of patients with intracranial complications increased sharply over time. Mastoidectomy rates doubled from 13.43% (pre\u2010COVID) to 28.40% (post\u2010COVID).\n                      <jats:italic>Streptococcus anginosus<\/jats:italic>\n                      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\u20108.6),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70391","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:53:56Z","timestamp":1786967636000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of COVID\u201019 Pandemic Response on Pediatric Mastoiditis\u2014The Australian Experience"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1050-1145","authenticated-orcid":false,"given":"William","family":"Li","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roi","family":"Kagan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinzi","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health Melbourne Australia"},{"name":"Murdoch Children's Research Institute Parkville Melbourne Australia"},{"name":"Department of Pediatrics The University of Melbourne, Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Nasserallah","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing M.","family":"Teh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Monash Health Melbourne Australia"},{"name":"Department of Surgery Melbourne University Melbourne Australia"},{"name":"Department of Medicine Nursing and Health sciences, Monash University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","first-page":"54","article-title":"Acute mastoiditis in children","volume":"91","author":"Cassano P","year":"2020","journal-title":"Acta Biomed"},{"issue":"1","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","DOI":"10.1038\/nrdp.2016.63","article-title":"Otitis media","volume":"2","author":"Schilder AGM","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"11","key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.3390\/v14112457","article-title":"The impact of the COVID\u201019 pandemic on otitis media","volume":"14","author":"Choi S\u2010Y","year":"2022","journal-title":"Viruses"},{"issue":"6","key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/S2589-7500(21)00077-7","article-title":"Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID\u201019 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative: a prospective analysis of surveillance data","volume":"3","author":"Brueggemann AB","year":"2021","journal-title":"Lancet Digit Health"},{"issue":"3","key":"e_1_2_8_6_1","first-page":"274","article-title":"Impact of the COVID\u201019 pandemic on the infectious disease epidemiology","volume":"64","author":"Facciol\u00e0 A","year":"2023","journal-title":"J Prev Med Hyg"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"104649","DOI":"10.1016\/j.amjoto.2025.104649","article-title":"Incidence and prognosis of otitis media with effusion in COVID\u201019 patients a comparative case\u2010control analysis","volume":"46","author":"Yu Q","year":"2025","journal-title":"Am J Otolaryngol"},{"issue":"6","key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1177\/00034894241241889","article-title":"Changes in otitis media during COVID\u201019","volume":"133","author":"Cho Y","year":"2024","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"2","key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3390\/v15020280","article-title":"The importance of RSV epidemiological surveillance: a multicenter observational study of RSV infection during the COVID\u201019 pandemic","volume":"15","author":"Pruccoli G","year":"2023","journal-title":"Viruses"},{"issue":"1","key":"e_1_2_8_10_1","article-title":"The acute bronchiolitis rebound in children after COVID\u201019 restrictions: a retrospective, observational analysis","volume":"94","author":"Curatola A","year":"2023","journal-title":"Acta Biomed"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"100195","DOI":"10.1016\/j.gpeds.2024.100195","article-title":"Covid lockdown and repaying the immunity debt in children","volume":"9","author":"Han P","year":"2024","journal-title":"Global Pediatrics"},{"issue":"6","key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/cid\/ciae493","article-title":"Cycles of susceptibility: immunity debt explains altered infectious disease dynamics post\u2010pandemic","volume":"81","author":"Munro AP","year":"2025","journal-title":"Clin Infect Dis"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.q1348","article-title":"Analysis reveals global post\u2010covid surge in infectious diseases","volume":"385","author":"Feinmann J","year":"2024","journal-title":"BMJ"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.idnow.2022.12.003","article-title":"Immune debt: recrudescence of disease and confirmation of a contested concept","volume":"53","author":"Cohen R","year":"2023","journal-title":"Infect Dis Now"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"114672","DOI":"10.1016\/j.jpeds.2025.114672","article-title":"Changes in clinical and microbiological characteristics of acute mastoiditis in children: a comparative study between 2001\u20102008 and 2021\u20102024","volume":"285","author":"Chebib E","year":"2025","journal-title":"J Pediatr"},{"issue":"9","key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"4747","DOI":"10.1007\/s00405-024-08704-y","article-title":"Increase in acute mastoiditis at the end of the COVID\u201019 pandemic","volume":"281","author":"Goldberg\u2010Bockhorn E","year":"2024","journal-title":"Eur Arch Otrhinolaryngol"},{"issue":"9","key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"4627","DOI":"10.1007\/s00405-024-08647-4","article-title":"Rise in complications of acute otitis media during and after the COVID\u201019 pandemic","volume":"281","author":"Hollborn H","year":"2024","journal-title":"Eur Arch Otrhinolaryngol"},{"issue":"7","key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/MAO.0000000000004238","article-title":"Tenfold increase: acute pediatric mastoiditis before, during, and after COVID\u201019 restrictions","volume":"45","author":"Draut S","year":"2024","journal-title":"Otol Neurotol"},{"issue":"2","key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4274\/tao.2025.2024-11-3","article-title":"Post\u2010pandemic surge in complications of acute otitis media","volume":"63","author":"Korkmaz M","year":"2025","journal-title":"Turk Arch Otorhinolaryngol"},{"key":"e_1_2_8_20_1","article-title":"Impact of the COVID\u201019 pandemic on the incidence of acute mastoiditis in a tertiary reference children's hospital in Brazil","author":"Neves HIA","year":"2025","journal-title":"Jornal de Pediatria"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"112407","DOI":"10.1016\/j.ijporl.2025.112407","article-title":"The evolving epidemiology of paediatric acute mastoiditis in New Zealand","volume":"195","author":"Stevenson J","year":"2025","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.1007\/s00405-025-09296-x","article-title":"Shifting patterns of acute otitis media and mastoiditis through COVID\u201019 era: analysis of pre\u2010pandemic, pandemic, and post\u2010pandemic dynamics","volume":"282","author":"Peyser\u2010Rosenberg M","year":"2025","journal-title":"Eur Arch Otrhinolaryngol"},{"issue":"5","key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1097\/MAO.0000000000004490","article-title":"Changes in the incidence of pediatric otitis media pre\u2010 and post\u2010COVID\u201019 pandemic in South Korea: a study utilizing a HIRA\u2010customized cohort for the population aged \u226418 years","volume":"46","author":"Eom T","year":"2025","journal-title":"Otol Neurotol"},{"issue":"3","key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"512225","DOI":"10.1016\/j.otorri.2025.512225","article-title":"ENT pediatric infection diseases and its relationship with COVID\u201019. Results of a retrospective cohort study in Madrid, Spain","volume":"76","author":"Asensi\u2010Diaz M","year":"2025","journal-title":"Acta Otorrinolaringol Esp"},{"issue":"1","key":"e_1_2_8_25_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1017\/S1744133121000244","article-title":"Australia's response to COVID\u201019","volume":"17","author":"Stobart A","year":"2022","journal-title":"Health Econ Policy Law"},{"issue":"16","key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"10400","DOI":"10.3390\/ijerph191610400","article-title":"Public health management of the COVID\u201019 pandemic in Australia: the role of the Morrison government","volume":"19","author":"Duckett S","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/MAO.0b013e31817f736b","article-title":"A systematic review of diagnostic criteria for acute mastoiditis in children","volume":"29","author":"den Aardweg MT","year":"2008","journal-title":"Otol Neurotol"},{"key":"e_1_2_8_28_1","unstructured":"Australian Institute of Health and Welfare. AIHW AG. COVID\u201019; 2024."},{"key":"e_1_2_8_29_1","unstructured":"SahiD NguyenH CallenderKD. Mastoiditis;2020."},{"issue":"5","key":"e_1_2_8_30_1","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.idnow.2021.05.004","article-title":"Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID\u201019 pandemic in childhood, how can we fill the immunity gap?","volume":"51","author":"Cohen R","year":"2021","journal-title":"Infectious diseases now"},{"key":"e_1_2_8_31_1","doi-asserted-by":"crossref","first-page":"112117","DOI":"10.1016\/j.ijporl.2024.112117","article-title":"A multicentre observational study of paediatric head and neck abscesses","volume":"186","author":"Davies T","year":"2024","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"6","key":"e_1_2_8_32_1","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.jinf.2020.03.017","article-title":"Immunologic dysfunction contributes to the otitis prone condition","volume":"80","author":"Pichichero ME","year":"2020","journal-title":"J Infect"},{"issue":"8","key":"e_1_2_8_33_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/INF.0b013e31821c2d8b","article-title":"Serum antibody response to five Streptococcus pneumoniae proteins during acute otitis media in otitis\u2010prone and non\u2013otitis\u2010prone children","volume":"30","author":"Kaur R","year":"2011","journal-title":"Pediatr Infect Dis J"},{"issue":"3","key":"e_1_2_8_34_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/ni0311-189","article-title":"Challenges in infant immunity: implications for responses to infection and vaccines","volume":"12","author":"PrabhuDas M","year":"2011","journal-title":"Nat Immunol"},{"issue":"1","key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/hpm.3326","article-title":"The COVID\u201019 pandemic in Australia: public health responses, opportunities and challenges","volume":"37","author":"Van Nguyen H","year":"2022","journal-title":"Int J Health Plann Manage"},{"issue":"3","key":"e_1_2_8_36_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.18773\/austprescr.2013.035","article-title":"Pneumococcal vaccines\u2013past, present and future","volume":"36","author":"Chiu C","year":"2013","journal-title":"Aust Prescr"},{"key":"e_1_2_8_37_1","first-page":"5","article-title":"Impact of coronavirus disease 2019 (COVID\u201019) on Ear, Nose and Throat (ENT) surgery waitlists in regional centres","author":"Tweddle E","year":"2022","journal-title":"Aust J Otolaryngol"},{"issue":"2","key":"e_1_2_8_38_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1001\/jamaoto.2013.1369","article-title":"The significance of Streptococcus anginosus group in intracranial complications of pediatric rhinosinusitis","volume":"139","author":"Deutschmann MW","year":"2013","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"8","key":"e_1_2_8_39_1","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1097\/INF.0000000000004346","article-title":"Increasing incidence of Streptococcus anginosus group intracranial infections associated with sinusitis, otitis media, and mastoiditis in children","volume":"43","author":"Hoyer EA","year":"2024","journal-title":"Pediatr Infect Dis J"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.70391","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ohn.70391","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.70391","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:54:01Z","timestamp":1786967641000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.70391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":38,"alternative-id":["10.1002\/ohn.70391"],"URL":"https:\/\/doi.org\/10.1002\/ohn.70391","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"assertion":[{"value":"2025-11-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ohn.70391"}}