Otologic features of bacterial meningitis of childhood.

Sixteen temporal bones from eight children who had died of meningitis were histopathologically evaluated. Concurrent acute otitis media was demonstrated in 14 bones. In no case could a pathway of infection from the tympanomastoid compartment to the intracranial cavity be located. Further, inner ear infection appeared to be the result of retrograde bacterial invasion from the meninges rather than from an inoculation via the middle ear or mastoid. Should surgical drainage be required, the histopathologic findings indicate that mastoidectomy would have little advantage over myringotomy. We infer that a child with normal temporal bone anatomy is probably not at enhanced risk for development of bacterial meningitis from acute otitis media via a route of direct extension.