To analyze the changes over the last 2 decades in clinical presentation, initial management, bacterial etiology, and rates of complications of acute mastoiditis (AM) in children.

We conducted a retrospective study including all children diagnosed with AM between 2021 and 2024 in a French tertiary care center. Age at diagnosis, first-line surgical and medical treatment modalities, complications and bacteriological findings were collected. These data were compared with those of a previously published cohort of AM between 2001 and 2008 from the same facility.

During the 3-year study period, 223 cases of AM were included (42 cases in 2021-2022; 104 in 2022 –2023; and 77 in 2023–2024). Among the 223 cases, 211 (95%) had a subperiosteal abscess (95%), 65 (29%) an extradural empyema, and 55 (25%) a lateral sinus thrombosis. The main pathogens identified were Streptococcus pyogenes (37%), Streptococcus pneumoniae (23%), and Fusobacterium necrophorum (19%). In cases of AM with intracranial complications, S. pyogenes and F. necrophorum were causative in over 70% compared with 46% in noncomplicated cases (P < .001). Comparing the 2021-2024 cohort with 2001-2008 cohort, we observed an increase in the number of cases (74 cases/year vs 27 cases/year), a rise in rate of intracranial complications (39% vs 4%; P < .001), an increase in performance of mastoidectomy (54% vs 33%; P < .001), and a shift in etiologic agents, with an increase in the proportion of S. pyogenes (P < .001) and F. necrophorum (P = .02) and concomitant decline in S. pneumoniae (P < .001).

This large, single-center study highlights clear changes in the clinical manifestations and bacterial etiology of AM over the past decades. Ongoing surveillance of the bacterial etiology of AM is essential to optimize its initial management.