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OBJECTIVE: Explore the impact of the COVID-19 pandemic on pediatric acute mastoiditis (AM). DATA SOURCES: CINAHL, Cochrane Library, PubMed, Scopus. METHODS: Literature was searched from 2014 to 2025 for articles reporting AM in children. Specific outcomes included clinical presentation, bacterial epidemiology, complications, and management. Primary outcome measures included continuous measures (mean), proportions (%), mean difference (Δ), and relative risk (RR) with 95 % confidence intervals (CI). RESULTS: There were seven included studies (N = 1001 children) with 632 patients in the pre-COVID cohort and 369 in the COVID-era cohort. There was a significant difference in the proportion of intracranial complications with a 20 % greater risk of having an intracranial complication after the COVID pandemic than before (RR: 1.2 [95 % CI: 0.6-2.3], p = 0.0097). There was also a significant decrease in the proportion of cases treated conservatively with antibiotics after the pandemic (mean difference 10.8 % [95 % CI: 2.9 %-18.0 %], p < 0.01). Bacterial epidemiology also experienced a significant shift in composition following the pandemic. CONCLUSION: The COVID-19 pandemic has led to a rise in intracranial complications in pediatric AM, with fewer cases being treated solely with antibiotics. Additionally, the pandemic has altered the bacterial epidemiological patterns of AM, highlighting opportunities for further investigation into the characteristics of AM during and after this period to inform and improve future management strategies.