Otogenic intracranial complications are rare, but could be life-threatening. Because of the great advances in antibiotic therapy and imaging techniques, the mortality rate and prevalence are on the decrease, but cases still do occur. Middle ear infection, for example chronic otitis media, acute otitis media, and cholesteatoma do rarely spread into the intracranial space to cause central nervous system complications, such as meningitis, brain abscess, lateral sinus thrombosis, etc. Sometimes, surgery is needed in addition to adequate antibiotic therapy for the treatment. We encountered 3 patients with meningitis complicating middle ear infection in the last 5 years. The 2 patients with cholesteatoma showed good outcomes after undergoing radical mastoidectomy, while the third patient with fungal malignant external otitis media died. Early surgical treatment possibly contributed to the better outcomes in the cholesteatoma cases. The patient with fungal malignant external otitis media showed bone erosion, which could have led to the meningitis. Resistance to antibiotics suggested the possibility of fungal infection, and cerebrospinal fluid examination helped in the diagnosis.
