Purpose <p>Otogenic meningitis is a rare but potentially life-threatening intracranial complication of otitis media (OM). Our aim was to study the incidence of childhood otogenic meningitis and to compare clinical presentation, causative pathogens, diagnostics, treatment, and outcome of otogenic versus non-otogenic meningitis.</p> Methods <p>Charts were reviewed for 47 children admitted to our tertiary center with bacterial meningitis (BM) between 2010 and 2020. Otoscopy and/or imaging were used to determine the otogenic meningitis ratio and the mean annual incidence was calculated.</p> Results <p>Eight (17%) of the 47 BM cases were otogenic [5 males; median age 1.3 years (range 2 months to 16 years)]. The otogenic meningitis incidence was 0.3/100 000/year. The classic triad of fever, altered level of consciousness, and meningeal irritation was more common in children with otogenic meningitis (50%, 4/8) than without OM (14%, 5/36) (<i>P = 0.042</i>). <i>Streptococcus pneumoniae</i> was a more common pathogen in children with OM (88%, 7/8) than without OM (14%, 4/29) (<i>P &lt; 0.001</i>), whereas <i>Neisseria meningitidis</i> infection occurred only in children without OM (41%, 12/29) (<i>P = 0.036</i>). Neurological sequelae at discharge were present in 3 (38%) children with OM. Deafness was diagnosed in two children, both with otogenic backgrounds. Three children showed long-term sequelae: 2 had deafness (aged &lt; 2 years) and 1 had aphasia/dysphasia.</p> Conclusion <p>The incidence of otogenic meningitis was 0.3/100 000/year, with <i>S. pneumoniae</i> the most common causative pathogen. Deafness was the most common long-term sequela and occurred only in children with otogenic meningitis.</p>