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:
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.
Venous plexus
Cochlear aqueduct
Cochlear nerve sheath
Bloodstream