Abstract
A woman aged 55 retained good hearing practically unchanged after removal of the malleus, incus and drum membrane during the course of acute otitis media, mastoiditis and meningitis. She had been examined a month prior to her present illness, when her hearing for the whispered voice was within normal limits but audiometric examination showed moderate decibel loss bilaterally. Subsequent examinations were made with the same audiometer and under the same conditions. The initial cell count of the spinal fluid was 9,000 per cubic millimeter. It is recognized that the higher the count and the older the patient, the less the chance for recovery. The intracranial pathway of extension of the tympanomastoid infection was not demonstrable at the time of operation; it may have been through venous channels. Various routes of intracranial extension, such as via the subarcuate fossa from infected parantral cells, through the dura beneath the gasserian ganglion and
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