De Bruyne N,Dhooge I,De Leenheer E,Van Driessche V,Coorevits L,Van Hoecke H, Pediatric Acute Mastoiditis: Recent Evolutions in Clinical Presentation and Microbiology Surgical Case Reports 2021 2613-5965 http://dx.doi.org/10.31487/j.SCR.2021.09.17 https://www.sciencerepository.org/pediatric-acute-mastoiditis_SCR-2021-9-117 Abstract: Acute mastoiditis is a well-known complication of acute otitis media in children. Last year we noticed some changes: more virulent pathogens, a more fulminant course of the disease and an increased need for surgical treatment in children with acute mastoiditis admitted to our hospital. Recently, other authors have raised the same concerns. Based on the last 12 consecutive cases of pediatric acute mastoiditis admitted to our hospital and a review of recent literature, we discuss a possible change in presentation, complication rate and microbiology in order to raise vigilance to a possibly changing pathology.Keywords: Acute mastoiditis, Pediatric, Children, Fusobacterium necrophorum, complicated acute mastoiditis, subperiosteal abscess, sinus thrombosis