Otogenic meningitis is by far the most common intracranial complication of ear infection In the setting of acute suppurative otitis media, it arises from hematogenous spread of bacteria, most commonly H influenzae and S pneumoniae In chronic otitis media, it results either from passage of infection along preformed pathways, such as the petrosquamous suture line, or from direct extension of disease through the dural plates of the petrous pyramid Epidural abscesses arise from direct extension of disease in the setting of chronic infection They are usually asymptomatic but may present with deep local pain, headache, and low-grade fever They are often discovered as an incidental finding at surgery Brain abscess may arise in the temporal lobe or cerebellum as a result of septic thrombophlebitis adjacent to an epidural abscess The predominant causative organisms are S aureus, S pyogenes, and S pneumoniae Rupture into the subarachnoid space results in meningitis and often death