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Tuberculous otitis media is a rare entity which requires high index of suspicion in an endemic country like India. A 38-year-old female with no prior history of tuberculosis or any predisposing factor presented to us with fever and altered sensorium. She was subsequently diagnosed to have disseminated tuberculosis with multiple cerebral tuberculomas. She complained of ear discharge which on further evaluation was established as smear positive tuberculous otitis media. This rare coexistence is seldom reported in literature.

Tuberculosis is a global health problem. Extrapulmonary tuberculosis remains to be a challenge in the diagnosis and treatment. Tuberculous otitis media being not so commonly diagnosed due to its varied presentation, early diagnosis and treatment remains to be a challenge. The aim of this study is to present the varied and unusual presentations and the importance of histopathological confirmation and new diagnostic tools like CBNAAT (cartridge based nucleic acid amplification test) which aids in the confirmation and to start anti-tubercular treatment (ATT). Five cases of tuberculous otitis media within a period of two years were included in the study. Among the five cases three cases presented with discharging sinuses, one with mastoid abscess and one with tuberculous otitis media with pulmonary origin. All five cases were confirmed with proper histopathological examination and two cases with CBNAAT (cartridge based nucleic acid amplification test) confirmation. Anti-tubercular treatment (ATT) was started and the patients were disease free. Tuberculous otitis media remains to be a rare complication of chronic suppurative otitis media and it has to be kept in mind while treating chronic suppurative otitis media. Classical presentations of tuberculous otitis media are not seen nowadays and the disease extending to the mastoid is the changing trend as the initial presentation. A proper suspicion with confirmation of the disease remains to be the gold standard for diagnosis and for treatment with anti-tubercular therapy.

We describe two cases of tuberculous otitis media studied with high-resolution computed tomography (CT). Findings included extensive soft tissue densities with fluid levels in the tympanic cavity, the antrum, the mastoid and petrous air cells. Multifocal bony erosions and reactive bone sclerosis were seen as well. CT proved valuable for planning therapy by accurately displaying the involvement of the various structures of the middle and inner ear. However, the specific nature of the disease could only be presumed.

1. Tuberculous otitis media in adults is usually secondary to tuberculosis elsewhere in the body. 2. The diagnosis rests on the painless onset of a thin mucopurulent discharge, together with marked deafness, rather than on laboratory methods. The only non-tubercular cases in which this is likely to occur are those in which there is an old-standing perforation of the tympanic membrane. 3. Multiple perforations of the membrana tympani occur in about one-third of the cases. 4. The chances of recovery from the local condition are fair. 5. Secondary infection by pyogenic organisms completely changes the clinical picture and renders the outlook more serious. When this takes place there is a marked tendency to luxuriant proliferation of granulation tissue. 6. The presence of a tuberculous otitis media indicates a severe infection, and justifies a grave prognosis of the general condition2. 7. Treatment should be confined to simple cleansing of the meatus, and the use of mild antiseptics. It is suggested that zinc ionization might give good results in a series of cases. Treatment of the lung infection is of major importance.

A case of tuberculous otitis media is presented. It was suspected at the time of operation by the presence of pale oedematous granulations, necrotic bone and bony sequestrum. It was confirmed by histopathological examination of granulation tissue and chest examination.

A case of tuberculous otitis media is being reported. It is a rare infectious disease and remains undiagnosed or confused with other acute or chronic middle ear infections, if appropriate diagnostic studies are not performed. Due to the confusion in the diagnosis of this disease, mild to severe complications develop early.