This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Ear, Subject name: ENT
Middle ear infections are known to spread to the brain from all of the following routes except 
Select and explain. 
A. Direct bony Invasion, B. Oval / Round window, C. Hematogenous spread, D. Lymphatic spread
D: Lymphatic spread
Answer: D: Lymphatic spread 
Explanation: Pathways of Spread of infection : Direct bone erosion Venous thrombophlebitis Preformed pathways Ref: Dhingra 7e pg 83.