Search Results (127)

Acute otitis media is an inflammatory disease affecting all compartments of the middle ear, characterized by localized pain, fever, hearing impairment, and, occasionally, purulent exudate. It represents a significant clinical concern in both pediatric and adult populations, with approximately 709 million cases reported annually worldwide, 51% of which occur in children. However, currently available topical otic formulations are limited by their inability to achieve predictable therapeutic concentrations at the site of inflammation, resulting in reduced efficacy. In addition, the selection of appropriate active pharmaceutical ingredients (APIs) for drug products remains challenging; as a result, existing therapies do not comprehensively address all stages of pathogenesis. This study aimed to analyze existing locally acting formulations for middle ear drug delivery, evaluate their advantages and limitations, and assess modern approaches to the development of novel drug delivery systems and API combinations. A critical review of 69 publications (2010–2026) was conducted, supplemented by a strengths and limitations analysis of dosage forms and an evaluation of APIs based on clinical data. The findings highlight a lack of targeted drug delivery systems, limited efficacy of existing API combinations against bacterial biofilms, and their risk of ototoxicity. Emerging innovative drug delivery approaches, including microemulsions, vesicular systems, stimuli-responsive systems, and hydrogels, have demonstrated promising results in preclinical studies; however, their efficacy and safety remain to be confirmed in clinical settings before their full therapeutic potential in otitis media treatment can be realized. Full article

Background and Objectives: Eustachian tube (ET) dysfunction links adenoidal disease to persistent middle ear dysfunction in children, yet the independent contribution of ET orifice obstruction grade to audiological outcomes and health-related quality of life remains unquantified after adjustment for anatomical and inflammatory confounders. Because conventional anatomical grading (e.g., the Cassano classification) does not directly characterize the degree of ET orifice compromise, it may underestimate the functional threat to middle ear ventilation; this study is the first to quantify the independent predictive value of endoscopic ET obstruction grade. This study aimed to evaluate ET obstruction grade as an independent determinant of hearing thresholds, middle ear pressure, and quality-of-life impairment in children with chronic adenoiditis and otitis media with effusion. Materials and Methods: A retrospective cohort of 236 children (aged 3–12 years) was analyzed. ET orifice obstruction was graded endoscopically as none, partial, or complete. Primary outcomes included pure tone average (PTA), middle ear pressure (MEP), and OSA-18 total score. Multivariate linear and logistic regression models were fitted, adjusting for age, sex, Cassano grade, neutrophil-to-lymphocyte ratio (NLR), allergic status, and acute otitis media frequency. The modifying role of mucosal appearance (edematous versus fibrotic/remodeling) on quality-of-life outcomes was also assessed. Results: ET obstruction was absent in 42 (17.8%), partial in 114 (48.3%), and complete in 80 (33.9%) children. PTA increased progressively across groups (22.2 ± 5.5 to 36.2 ± 6.7 dB; p < 0.001), as did OSA-18 scores (44.9 ± 7.9 to 80.4 ± 10.3; p < 0.001). In adjusted analysis, each obstruction increment independently predicted a 5.57 dB PTA increase (95% CI 4.37–6.77; p < 0.001), a 14.89-point OSA-18 increase (95% CI 12.87–16.92; p < 0.001), and 5.12-fold higher odds of PTA > 30 dB (95% CI 2.84–9.24; p < 0.001). Persistent middle ear dysfunction at six months occurred in 7.1%, 26.3%, and 61.3% across obstruction grades. Among children with complete obstruction, fibrotic mucosa was associated with higher OSA-18 scores than edematous mucosa (82.3 vs. 76.8; p = 0.02). Conclusions: ET obstruction grade independently determines audiological and quality-of-life outcomes in pediatric chronic adenoiditis. Mucosal remodeling further amplifies quality-of-life burden in complete obstruction. These findings support routine ET endoscopic grading in pediatric otorhinolaryngology risk stratification. Full article

Background/Objectives: Recurrent acute otitis media (AOM) in children is known to cause cumulative cochlear and vestibular injury. Whether a single fulminant episode severe enough to require surgical intervention produces an analogous long-term audiovestibular signature, and whether infection severity contributes to outcome independently of cumulative episode count, is unclear. The present study addressed this gap. Methods: In this single-centre retrospective cohort study, 65 paediatric patients who had undergone surgical treatment for acute mastoiditis—the fulminant form of AOM—between July 2001 and March 2021 were assessed a median of 11.5 years after surgery. Of these, 35 had undergone mastoidectomy with tympanostomy and 30 had undergone tympanostomy alone because their episode had not been severe enough to require mastoidectomy. Thirty-two age-matched healthy volunteers (one ear each) formed the control group, yielding 97 ears in three groups (Group TM, 35 ears; Group T, 30 ears; Group C, 32 ears). Extended high-frequency pure-tone audiometry (125–20 kHz), distortion-product otoacoustic emissions (DPOAEs), single-frequency and wideband tympanometry, ipsilateral acoustic reflex thresholds, and lateral-canal vestibulo-ocular reflex gain were measured. Results: Both operated groups showed significantly elevated audiometric thresholds in the high- and extended high-frequency ranges compared with controls (HTA: χ² = 24.25, p < 0.001), with corresponding reductions in DPOAE amplitudes (HTA: χ² = 25.04, p < 0.001). Group TM did not differ significantly from Group T at any frequency band, indicating a negligible additional contribution of mastoidectomy itself. Acoustic reflex thresholds were elevated in Group TM. Vestibulo-ocular reflex gain was within reference ranges in all groups. Conclusions: A single fulminant episode of acute middle-ear infection in childhood—whether severe enough to require mastoidectomy or treated by tympanostomy alone—was associated, more than a decade later, with significantly elevated audiometric thresholds closely resembling those reported after multiple recurrent infections, supporting an effect of infection severity independent of cumulative episode count. Long-term audiological follow-up with extended high-frequency audiometry and otoacoustic emission testing is warranted, irrespective of whether mastoidectomy was required. Full article

Background/Objectives: Otorhinolaryngologic (ENT) complaints constitute a substantial proportion of emergency department (ED) visits, ranging from minor to life-threatening problems. The patterns and frequency of these presentations in Saudi Arabia remain poorly described. This study, therefore, aimed to address this gap by examining the most frequent ENT-related presentations to the ED at a tertiary center in Riyadh, Saudi Arabia, to identify common diagnoses, describe patient demographics, and evaluate annual trends in ED visits. Methods: A retrospective study of all consecutive ENT-related emergency department visits between January 2019 and December 2024 was conducted at King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia. Diagnosis classification used the International Classification of Diseases, 10th Revision (ICD-10). Data on patient demographics, presenting complaints, and hospital admissions were extracted. Descriptive analyses were performed to assess annual trends and common diseases. Results: A total of 22,014 patients were included in the present study, with a slight male (54%) predominance. Across 34,290 ED visits, annual presentations were the highest in 2019 (23.9%) and lowest in 2020 (9.2%). Most patients were discharged from ED (91.9%). The most frequent diagnoses were acute pharyngitis (29.1%), acute tonsillitis (26.2%), and otitis media (22.3%). Conclusions: The study examined the otorhinolaryngology conditions most frequently encountered in an ED setting. The findings highlight a range of ENT disorders that are commonly seen in this setting. Recognizing these prevalent conditions and their patterns can improve ED physicians’ preparedness, triage, and management of patients presenting with ENT emergencies. Full article

Background/Objectives: Acute otitis media (AOM) remains a leading cause of pediatric morbidity and a primary indication for antibiotic prescription worldwide. Given the potential for serious complications and the evolving landscape of antimicrobial resistance, up-to-date epidemiological data on causative bacteria are essential. This study aimed to assess the global prevalence of major bacterial pathogens in pediatric AOM and evaluate variations across geographic regions and temporal periods (pre-2000 vs. post-2000). Methods: A systematic search of PubMed, Embase, and Web of Science (1980–2025) was conducted to identify studies reporting middle ear fluid culture results in children (0–18 years) with AOM. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 45 studies encompassing 16,305 AOM episodes were included. Data were synthesized from North America, Europe, the Middle East, Asia, Oceania, and Africa. Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed via the I² statistic. Results: The overall pooled culture-positive rate was 66.6% (95% CI, 62.2–70.8%). Regional pooled estimates ranged from 56.1% in the Middle East (95% CI, 40.3–70.6%; underlying counts, 3776/10,652) to 77.5% in North America (95% CI, 68.2–84.7%; underlying counts, 1567/2125). Streptococcus pneumoniae was the most prevalent pathogen, with a pooled proportion of 29.0% (95% CI, 26.3–31.8%), followed by Haemophilus influenzae (22.3%; 95% CI, 19.3–25.6%) and Moraxella catarrhalis (4.6%; 95% CI, 3.4–6.1%). While S. pneumoniae remained the leading pathogen in most regions, H. influenzae showed marked geographic variability, peaking in the Middle East at 27.5% (95% CI, 17.0–41.2%; underlying counts, 2280/10,652) and reaching its lowest level in Asia at 13.5% (95% CI, 7.8–22.4%; underlying counts, 336/1854). The pooled culture-positive rate declined from 72.5% before 2000 (95% CI, 67.6–76.9%; underlying counts, 5769/8199) to 59.4% in 2000 and later (95% CI, 52.1–66.3%; underlying counts, 6661/15,707), although S. pneumoniae remained the predominant isolate in both periods. Conclusions: S. pneumoniae remains the primary bacterial driver of pediatric AOM globally. However, the observed geographic disparities and the temporal shift in pathogen prevalence following pneumococcal conjugate vaccine (PCV) introduction underscore the necessity for region-specific empirical antibiotic selection. These findings highlight the critical need for sustained microbiological surveillance to inform future vaccination and treatment strategies. Full article

Background/Objectives: Streptococcus pneumoniae remains a major cause of morbidity and mortality in Egypt, yet pneumococcal conjugate vaccines (PCVs) are not included in the national immunization program. Recent commitments to domestic vaccine manufacturing and temporary Gavi support create a timely decision context for policymakers to assess whether PCV introduction is cost-effective, affordable, and sustainable within Egypt’s health financing constraints. This study evaluates the cost-effectiveness, budget impact, and return on investment (ROI) of PCV introduction in Egypt. Methods: A deterministic, age-structured dynamic transmission model was developed to estimate the health and economic outcomes of PCV introduction over a 20-year horizon from a healthcare payer perspective. The analysis was conducted in line with the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) guidelines. The model captures direct and indirect effects across all age groups and includes pneumonia, meningitis, non-pneumonia non-meningitis invasive disease, and acute otitis media. Scenarios assessed immediate versus delayed introduction, alternative PCV10-to-PCV13 pathways, and domestic manufacturing price assumptions. Outcomes included deaths averted, incremental cost-effectiveness ratios (ICERs) relative to GDP per capita, budget impact, and ROI using the value of statistical life. Results: Immediate PCV13 introduction was projected to avert 139,451 deaths across all age groups over 20 years, with an ICER of 523.31 USD per DALY averted equal to 0.16 × GDP per capita. The total budget impact was USD 124.9 million per year without Gavi support and USD 120.9 million with support, yielding an ROI of 23.1. Delaying the introduction substantially reduced health gains and economic returns. Pathways involving initial PCV10 introduction followed by transition to PCV13 achieved similar health outcomes with a lower budget impact and higher ROI. Conclusions: PCV introduction in Egypt represents a high-value investment. Immediate introduction maximizes health and economic benefits, while delayed introduction entails substantial opportunity costs. Alternative PCV10-to-PCV13 pathways offer a more affordable route with a similar long-term impact. Full article

Background/Objectives: Otitis media (OM), including acute otitis media (AOM) and chronic otitis media (COM), is a common middle ear disease that can lead to significant morbidity if not accurately diagnosed. Otoscopic interpretation remains subjective and operator-dependent, underscoring the need for objective and reproducible diagnostic support. Recent advances in artificial intelligence (AI) offer promising solutions for automated otoscopic image analysis. Methods: We developed an AI-based diagnostic framework consisting of three sequential steps: (1) semi-supervised learning for automatic recognition and semantic segmentation of tympanic membrane structures, (2) region-based feature extraction, and (3) disease classification. A total of 607 clinical otoscopic images were retrospectively collected, including normal ears (n = 220), AOM (n = 157), and COM with tympanic membrane perforation (n = 230). Among these, 485 images were used for training and 122 for independent testing. Semantic segmentation of five anatomically relevant regions was performed using multiple convolutional neural network architectures, including U-Net, PSPNet, HRNet, and DeepLabV3+. Following segmentation, color and texture features were extracted from each region and used to train a neural network-based classifier to differentiate disease states. Results: Among the evaluated segmentation models, U-Net demonstrated superior performance, achieving an overall pixel accuracy of 96.76% and a mean Dice similarity coefficient of 71.68%. The segmented regions enabled reliable extraction of discriminative chromatic and texture features. In the final classification stage, the proposed framework achieved diagnostic accuracies of 100% for normal ears, 100% for AOM, and 91.3% for COM on the independent test set, with an overall accuracy of 96.72%. Conclusions: This study demonstrates that a semi-supervised, segmentation-driven AI pipeline integrating feature extraction and classification can achieve high diagnostic accuracy for otitis media. The proposed framework offers a clinically interpretable and fully automated approach that may enhance diagnostic consistency, support clinical decision-making, and facilitate scalable otoscopic assessment in diverse healthcare screening settings for disease prevention and health education. Full article

Background: Streptococcus pneumoniae is currently the leading cause of acute bacterial meningitis. This study assessed the impact of pneumococcal conjugate vaccines (PCVs) on pneumococcal meningitis in Gipuzkoa, north of Spain, between 1993 and 2023. Methods: All cases were serotyped and tested for antimicrobial susceptibility, with medical records reviewed since 2013. Overall, 193 patients were diagnosed (178 patients), averaging 6.2 cases annually. Results: Pneumococcal meningitis annual incidence decreased significantly after PCVs introduction, from 1.99 cases per 100,000 inhabitants in 1993–2001 (before PCV7) to 1.64 in 2002–2010 (PCV7 period) and further to 1.13 in 2011–2023 (PCV13 period). This decline was observed in all age groups except for adults aged ≥65 years, in whom the reduction was observed only after PCV13 introduction. The greatest reduction was observed in children under five. The incidence of meningitis caused by vaccine serotypes decreased following the progressive introduction of PCVs, but non-PCV serotypes increased from 0.70 to 0.95 cases per 100,000 between 1993–2001 and 2011–2023. Otitis media was the most common source of infection, followed by CSF fistula. Most cases (85%) required ICU admission; 67.5% showed sequels at discharge, mainly sensorineural hearing loss, and the 30-day mortality rate was 11.1%. Recurrent pneumococcal meningitis represented 7.8% of cases, associated with head trauma, with favorable outcomes and no mortality. Between 1993–2001 and 2002–2010, penicillin and cefotaxime resistance decreased from 25.4% to 13.3% (47.6% reduction) and from 19.7% to 5% (74.6% reduction), respectively. In 2011–2023, cefotaxime resistance stabilized, but penicillin resistance rose to 32.3%, mainly due to non-PCV13 serotypes. Conclusions: The use of PCV reduced the incidence of pneumococcal meningitis in the region, but penicillin resistance has increased in recent years, due to the rise in non-PCV13 serotypes. Full article

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition while also describing its clinical and epidemiological characteristics. Materials and Methods: This study combined an analysis of national healthcare and demographic statistics in Kazakhstan from 1998 to 2024 with a retrospective review of pediatric AM patients treated at a tertiary referral center. Long-term trends in healthcare resources were assessed, and future needs were projected via average annual percentage change (AAPC) and time series forecasting methods. Clinical, laboratory, and radiological data were extracted from medical records. Statistical analyses were performed via SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Results: From 1998 to 2024, the number of pediatricians and ENT hospital beds declined, whereas the density of ENT physicians remained relatively stable, and the proportion of ENT surgical procedures increased. Projections to 2030 suggest continued constraints in pediatric and ENT workforce capacity and further reductions in inpatient beds despite sustained growth in surgical demand. Among 95 pediatric AM cases, complications, most commonly subperiosteal abscess and zygomatic abscess, were identified in 40% of patients. Conclusions: AM may be considered a contextual indicator of pressures within specialized pediatric ENT services rather than a direct measure of healthcare system performance. These findings highlight the need for further studies to validate these observations and better inform healthcare planning. Full article

Purpose: Tympanostomy tubes are essential for middle ear ventilation, but conventional long-term tubes carry high perforation rates (12–22%). This study evaluated the Tympanostomy U-Tube (TUT), a novel silicone-based tube designed to minimize perforation risk by redistributing pressure away from the tympanic membrane rim. Methods: This was a retrospective cohort study of 192 ears in children aged 1–4 years who underwent TUT insertion for chronic otitis media with effusion or recurrent acute otitis media. The primary outcomes were tube insertion time and the permanent perforation rate. Mean follow-up was 38.4 months. Results: Mean tube insertion time was 21.6 months. Spontaneous extrusion occurred in 18.2% of ears (mean 24.5 months), while 81.8% underwent elective removal (mean 21.0 months). Permanent perforation developed in only 4 ears (2.08%; 95% CI: 0.6–5.2%), substantially lower than rates reported in the literature for conventional long-term tubes (12–22%), although the retrospective design and reliance on historical controls limit direct comparison. Complications were minimal, with otorrhea (36%) responding to topical therapy. Office-based removal was successful in all cases. Conclusions: The TUT provides intermediate-duration ventilation with a perforation rate comparable to that of short-term tubes, while avoiding the high perforation rates of conventional long-term tubes. Prospective randomized trials are needed to validate these findings. Full article

Otitis media with effusion (OME) is a common middle ear disease characterized by fluid accumulation without acute infection, leading to conductive hearing loss. Conventional diagnostic tools, such as tympanometry and otoscopy, have limited sensitivity and rely on expert interpretation. This study investigates vibro-acoustic radiation (VAR) as a novel, non-invasive, and objective method for OME detection. VAR signals were obtained from 36 OME patients (43 ears) and 15 normal ears using bone-conduction excitation and stereo microphones, and the frequency response functions were analyzed. OME increases the mechanical loading of the tympanic membrane and ossicular chain, thereby modifying sound transmission across the middle ear. Using a simplified theoretical model, we estimated acoustic parameters of the ear canal, eardrum, and middle ear, including specific acoustic impedance and resonance frequency ranges, to interpret changes in VAR. VAR analysis revealed significantly reduced signal amplitude in the 8–10 kHz range in OME ears compared with normal ears (p < 0.05). A classification algorithm based on these features achieved 86.7% accuracy, 85.0% sensitivity, and 80.0% specificity, with an area under the ROC curve of 0.986. These findings suggest that VAR has strong potential as a non-invasive diagnostic tool for OME, warranting validation in larger clinical studies. Full article

Background: Acute otitis media (AOM) is one of the most common pediatric infections. We aimed to investigate the bacterial profile of AOM in children, the serotype distribution, and the main genetic virulence factors involved in adhesion, immune evasion, and tissue spread. Methods: In total, 121 AOM cases involving children aged 0 to 14 years were studied. Middle ear fluids (MEF) (n = 42) and nasopharyngeal samples (n = 79) were collected. All strains were identified using routine microbiological tests, conventional PCRs and real-time PCR methods. Molecular serotyping was performed for S. pneumoniae and H. influenzae isolates. An immunofluorescence serotyping technique was employed for M. catarrhalis. Target genetic factors were determined for all involved bacterial agents using singleplex or multiplex PCRs. Results: We analyzed 148 nasopharyngeal and MEF. Among 121 AOM cases, a total of 127 bacterial agents were identified, including S. aureus (n = 41), S. pneumoniae (n = 28), H. influenzae (n = 23), M. catarrhalis (n = 19), and S. pyogenes (n = 16). The leading three serotypes among S. pneumoniae were: 19A (18.0%), 6A (14.3%), and 15B (14.3%). 91.3% of H. influenzae isolates were non-typeable (lacking a capsule—NTHi). The M. catarrhalis isolates were distributed in serotypes A (57.9%), B (26.3%), and C (15.8%). Presence of pili type 1 was detected in 21.4% pneumococci, and the fimbrial gene hifA was found in 34.8% of the H. influenzae strains. In 73.6% of the M. catarrhalis strains, ompCD was identified, while 84.2% contained ompE. 62.5% of the S. pyogenes isolates harbored the sdc gene, and 56.2% possessed the sdaD gene, predominantly in the MEF isolates. The cna adhesin was found in 28.0% of the S. aureus strains. Conclusions: The monitoring of bacterial pathogens responsible for otitis media, along with their serotype distribution and the prevalence of genetic factors involved in disease pathogenesis, is essential for public health and can help predict disease severity and treatment options. Full article

Otitis media is among the most common pediatric illnesses globally, constituting a leading cause of antimicrobial prescriptions, recurrent medical consultations, and preventable hearing loss in early childhood. Traditionally regarded as a sterile cavity intermittently invaded by pathogens, the middle ear is now recognized as a dynamic ecological niche influenced by anatomical immaturity of the Eustachian tube, host immune development, and the composition of resident microbial communities. Increasing evidence demonstrates that microbial dysbiosis and the establishment of biofilms are central to the persistence and recurrence of disease. This review synthesizes current knowledge of the pediatric middle ear microbiome, highlighting how commensal organisms contribute to mucosal resilience and colonization resistance, whereas pathogenic bacteria exploit ecological disruption to establish biofilm communities. Biofilm formation provides bacteria with enhanced survival through immune evasion, altered microenvironments, and antibiotic tolerance, thereby transforming acute otitis media into recurrent or chronic states. Furthermore, studies demonstrate how adenoids act as reservoirs of biofilm-forming organisms, seeding the middle ear and perpetuating infection. The emerging ecological perspective emphasizes the limitations of conventional antibiotic-centered management and directs attention toward innovative strategies, including microbiome-preserving interventions, probiotic or live biotherapeutic approaches, and antibiofilm agents. By defining pediatric otitis media as a disorder of disrupted host–microbe equilibrium, future research may pave the way for precision-based preventive and therapeutic strategies aimed at reducing the global burden of this pervasive disease. Full article

Background/Objectives: Accurate diagnosis of otitis media (OM) using otoscopic images is often challenging, particularly for non-specialists. Artificial intelligence (AI), especially deep learning-based methods, has shown promising results in supporting the classification of tympanic membrane conditions. This study aimed to develop and validate a multi-step CNN-based AI diagnostic pipeline for the automated classification of tympanic membrane images into four OM categories: normal, acute otitis media (AOM), otitis media with effusion (OME), and chronic otitis media (COM). Methods: A total of 2964 otoscopic images were retrospectively collected and annotated by expert otologists. The proposed pipeline consisted of four sequential stages: image quality assessment, tympanic membrane segmentation, side (left/right) classification, and final disease classification. CNN-based deep learning models including MambaOut, CaraNet, EfficientNet, and ConvNeXt were employed in each stage. Results: The image quality classifier achieved an accuracy of 98.8%, while the laterality classifier reached 99.1%. For disease classification, the ConvNeXt model demonstrated an overall accuracy of 88.7%, with disease-specific F1-scores of 0.78 for AOM, 0.87 for OME, and 0.92 for COM. The system performed reliably across all stages, indicating strong potential for clinical application. Conclusions: The proposed AI pipeline enables automated and accurate classification of tympanic membrane images into common OM subtypes. Its integration into digital otoscopes could support more consistent diagnosis in primary care and underserved settings, while also providing educational support for trainees and general practitioners. Full article

Background: Acute mastoiditis is the most frequent suppurative complication of acute otitis media in children. AM can lead to both extracranial complications and intracranial complications. Recent studies suggest an increase in cases after the COVID-19 pandemic. Objective: To compare the epidemiological and clinical characteristics of pediatric patients diagnosed with acute mastoiditis admitted to Santobono-Pausilipon Children’s Hospital before and after COVID-19. Methods: We conducted a retrospective study including all patients aged 0–16 years with AM admitted to our hospital between January 2017 and December 2024. Patients were stratified into three groups: pre-COVID-19: 1 January 2017–28 February 2020; COVID-19: 1 March 2020–31 December 2021; and post-COVID-19: 1 January 2022–31 December 2024. Demographic data, clinical presentations, complications, laboratory findings, and treatment modalities were analyzed and compared between groups. Results: A total of 276 children (153 males and 123 females; median age: 49 months, age range: 1–177 months) were included. Hospital admissions for AM increased in the post-COVID-19 period, reaching more than a threefold increase in 2024 compared with the pre-COVID-19 years. Similar to the overall number of AM cases, the absolute number of complications, especially IC, such as thrombosis and empyema, increased. The rate of surgical procedures increased during the post-COVID-19 period, with an overall increase of 88.5%. Both the duration of antibiotic therapy and hospital stay were significantly longer in the post-COVID-19 period. Conclusions: The COVID-19 pandemic has been associated with epidemiological and clinical changes in pediatric AM patients. These findings highlight the need for effective preventive strategies, including enhanced vaccination coverage and the promotion of early diagnosis. Additionally, implementing standardized clinical protocols could support more efficient and consistent management, reducing hospital stays and recurrence rates. Full article