Aims The aims of this study were to investigate the risk factors associated with otogenic meningitis (OgM) and assess the adequacy of Ear Nose and Throat (ENT) and audiological care in a tertiary centre. Methodology A retrospective cohort study over 10 years (2014 – 2024) identified 39 patients with OgM. The cohort was divided into two: an earlier cohort 1 (n=20, 2014-2018) and a later cohort 2 (n=19, 2018-2024). Data was retrieved from medical records, including age, gender, BMI, medical and social history, clinical examination, microbiological, radiologic, and audiological findings, as well as ENT management. Statistical analysis compared findings between cohorts. Results Both cohorts shared similar demographics (middle-aged and high BMI). The mean age of both cohorts was 54.5 years, and the mean BMI was 31.1 kg/m^2. Of the 15 patients in cohort 2 whose BMI data was available, 86.67% were overweight or obese, compared to 65.8% of the Australian population. The rate of obstructive sleep apnoea (OSA) was higher in cohort 2 (36.8%), compared to cohort 1 (5%) (p=0.014). In cohort 2, otoscopy was conducted on 66.7% of patients during initial examination in the ED and audiology follow up rates were higher (84.2%) compared to cohort 1 (55%) (p=0.048) but the average time to assessment was 35.2 days. The clinical impact was notable in the later cohort, with an average hospital stay of 20 days, average ICU stay of 6.4 days, and a combined ICU stay of 109 days. Post-infection sequelae included hearing loss and dizziness in 31.6% of patients, and a mortality rate of 10.5%. Conclusion Increased BMI and presence of OSA may be risk factors for OgM. Despite higher rates of otoscopy and more frequent audiological follow up over time, there remains significant long-term sequelae and mortality. Earlier identification, prompt intervention, and timely audiological and ENT follow-up is needed, as well as further research into how BMI and OSA relate to the pathophysiology of OgM.