A rare presentation of Tuberculous otitis media in an immunocompetent adult: Case report and literature review

Tuberculous otitis media (TOM) is a rare manifestation of extrapulmonary tuberculosis, representing less than 1% of chronic middle ear infections in developed countries. Its nonspecific presentation often mimics other chronic otitis media forms, leading to underdiagnose it, especially in resource-limited settings. A 50-year-old female presented with odorless, colorless otorrhea from the left ear for two weeks, without pain or systemic symptoms. She had a history of pulmonary tuberculosis diagnosed eight months earlier, but discontinued treatment after three months. On otoscopy, we observed purulent secretions and three tympanic membrane perforations. Polymerase chain reaction of the ear discharge confirmed Mycobacterium tuberculosis. Audiometry revealed a 25 dB air-bone gap, consistent with mild to moderate conductive hearing loss, while temporal bone CT showed no abnormalities. She received standard quadruple anti-tuberculous therapy for two months, followed by dual therapy for four months. After completing treatment, we performed tympanoplasty with a temporalis fascia graft. Clinicians should suspect TOM in chronic otitis media unresponsive to conventional therapy, particularly in patients with an active TB history. The disease may spread hematogenously or through the Eustachian tube. Classic signs such as painless otorrhea, multiple perforations, and facial palsy are now less frequent. PCR offers rapid confirmation, and early therapy prevents irreversible complications. This case emphasizes the need for clinician awareness, timely treatment, and adherence to therapy. Integrating TB screening into the evaluation of atypical chronic otitis media remains essential, especially in patients with a story of active TB.