A child is brought to the emergency depament with signs of meningeal irritation. She had suppurative otitis media in the last week. Infection of middle ear can spread to CNS through:: (A) Venous plexus, (B) Cochlear aqueduct, (C) Cochlear nerve sheath, (D) Bloodstream
Answer is B. In the setting of middle ear infection, bacterial infection can invade through the round window causing acute suppurative labyrinthitis. From the labyrinth, bacteria gain access to the cochlear aqueduct, forming a conduit between the perilymph and the cerebrospinal fluid (CSF) resulting in meningeal infiltration.