<prompt> 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:Venous plexusCochlear aqueductCochlear nerve sheathBloodstream  <response>: 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. 