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14368 Medicine

A 5-year-old boy presents to the clinic for evaluation of symptoms of left ear pain and associated fever. On physical examination, the left eardrum is inflamed with a small perforation in it and pus is seen in the external canal. A swab of the fluid grows S pneumoniae. Which of the following is the most likely mechanism for S pneumoniae to cause otitis media?

Ahematogenous spread
Bdirect extension from the nasopharynx
Cdirect inoculation on the ear
Dspread through lymphatic tissue
Medicine
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