{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:14:17Z","timestamp":1785838457382,"version":"3.56.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T00:00:00Z","timestamp":1748044800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T00:00:00Z","timestamp":1748044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005187","name":"University of Athens","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005187","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>This study aims to evaluate the impact of COVID-19 pandemic on the incidence, microbiological characteristics, management, and outcomes of mastoiditis and orbital cellulitis and their intracranial complications in pediatric patients. A retrospective observational study was conducted at the major pediatric hospital of Athens from 1\/2018 to 12\/2023. Pediatric patients (0\u201316\u00a0years) diagnosed with mastoiditis, orbital cellulitis, and related complications were included. Data were collected across three periods: pre-pandemic (1\/2018\u20133\/2020), during the pandemic (4\/2020\u20136\/2021), and post-pandemic (7\/2021\u201312\/2023). Statistical analyses compared demographic, clinical, and microbiological characteristics between the periods. A total of 176 cases were included (76 mastoiditis and 100 orbital cellulitis cases). The in-hospital incidence of both infections increased significantly post-pandemic compared to the period before the pandemic (mastoiditis: 5.5 vs.13.6 per 1000 admissions; orbital cellulitis: 4.8 vs. 21.8 per 1000 admissions, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). <jats:italic>Streptococcus<\/jats:italic> and <jats:italic>Staphylococcus<\/jats:italic> species predominated across the three periods. Median (IQR) age was not significantly different between the two periods among patients with mastoiditis (pre-pandemic: 5.6 (3.5) years vs. post-pandemic: 3.3 (3.4) years, <jats:italic>P<\/jats:italic>\u2009=\u20090.12) and among patients with orbital cellulitis (pre-pandemic: 9.2 (6.6) years vs. post-pandemic: 8 (9.2) years, <jats:italic>P<\/jats:italic>\u2009=\u20090.50). Regarding the complications, the rate of intracranial empyema\/abscess development among patients with orbital cellulitis, but not mastoiditis, was lower post-pandemic compared to pre-pandemic (30% vs. 10.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.03).<\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusion<\/jats:italic>: The study findings demonstrate a significant rise in the post-COVID-19 in-hospital incidence of mastoiditis and orbital cellulitis in children. Future epidemiological surveillance of these complications and pathogen-specific dynamics, are important to develop prevention strategies for these severe pediatric infections. \n<jats:table-wrap>\n              <jats:table>\n                <jats:tbody>\n                  <jats:tr>\n                    <jats:td align=\"left\">\n                      <jats:bold>What is Known:<\/jats:bold>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\u2022 <jats:italic>The COVID-19 pandemic shifted the epidemiology of severe upper respiratory tract infections.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\u2022 <jats:italic>Data on the epidemiology of severe sinogenic and otogenic infections and their intracranial complications during and after the acute phase of the COVID-19 pandemic are limited in Europe.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\n                      <jats:bold>What is New:<\/jats:bold>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\u2022 <jats:italic>This study highlights a notable increase in the in-hospital incidence of mastoiditis and orbital cellulitis during the post-COVID-19 pandemic era, likely associated with immunity debt and alterations in respiratory microbiota.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                  <jats:tr>\n                    <jats:td align=\"left\">\u2022 <jats:italic>Despite the increase in pediatric mastoiditis and orbital cellulitis cases, the rates of complications and surgical management remained stable throughout the study period.<\/jats:italic>\n                    <\/jats:td>\n                  <\/jats:tr>\n                <\/jats:tbody>\n              <\/jats:table>\n            <\/jats:table-wrap>\n          <\/jats:p>","DOI":"10.1007\/s00431-025-06188-4","type":"journal-article","created":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T02:17:01Z","timestamp":1748053021000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of COVID-19 on the epidemiology of severe sinogenic and otogenic infections and their intracranial complications"],"prefix":"10.1007","volume":"184","author":[{"given":"Dimitra","family":"Dimopoulou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M.","family":"Berikopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Tsoliakos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Michos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,24]]},"reference":[{"key":"6188_CR1","doi-asserted-by":"publisher","unstructured":"Cinaroglu S (2020) Prevalence of upper respiratory tract infections and associated factors among children in Turkey. 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