Pediatric acute mastoiditis: an Italian multicenter retrospective study of clinical, microbiological, and radiological features.

Acute mastoiditis (AM) is the most common intratemporal complication of acute otitis media in children. This multicenter study aimed to describe the epidemiological, clinical, microbiological, and radiological features of pediatric AM in four Italian regions and to identify factors associated with radiologic complications. This retrospective, observational cohort study included all patients under 18 years hospitalized with AM in the pediatric departments of Bari, Forlì, Macerata, and Pescara between January 2022 and May 2025. Demographic, clinical, microbiological, imaging, and management data were extracted from medical records using a standardized form and analyzed descriptively. Logistic regression explored associations between clinical variables and radiologic complications. A total of 118 hospitalizations (117 children; median age 4 years, IQR 2-7.8; 56% males) were analyzed. The estimated annual hospitalization rate was approximately 23 per 100 000 children. Otalgia (70%), postauricular swelling (57%), and erythema (56%) were common presenting features. Clinical complications occurred in 25 (21%) patients, and surgery was required in 13 (11%). Microbiological testing was positive in 38 (32%) episodes, most frequently identifying Streptococcus pyogenes or Pseudomonas aeruginosa. Imaging was performed in 70 (59%) episodes, revealing radiologic complications in 20 (17%; 28.5% of imaged). In multivariable analysis, auricular protrusion was independently associated with a lower likelihood of radiologic complications (p = 0.018), whereas no other clinical variable independently predicted radiologic complications.

conclusionAM remains a relevant cause of hospitalization in Italian children. Most patients respond well to medical therapy, whereas surgical intervention is required for complicated presentations. The significant protective role of auricular protrusion supports the selective use of imaging and suggests a conservative management approach in most cases. WHAT IS KNOWN: • Acute mastoiditis (AM) is the most frequent intratemporal complication of acute otitis media in children. • Despite antibiotic and vaccine advances, AM remains a relevant cause of pediatric hospitalizations. • Most children respond to medical therapy, but some require surgical drainage. WHAT IS NEW: • This multicenter study provides the first post-pandemic overview of pediatric AM across four Italian regions. • Radiologic complications occurred in 17% of cases; auricular protrusion independently predicted a lower risk of severe imaging findings. • The findings highlight a post-pandemic rebound of AM and support conservative, standardized management.