Key points

1) Tuberculous otitis media is a rare entity-Is it Rare? Or is the diagnosis missed?

2) Classical clinical features of tuberculosis are rarely seen and atypical findings which help in diagnosing should be kept in mind.

3) Zn staining for tuberculosis should not be considered as a sensitive test.

4) Histopathology is considered as diagnostic in the diagnosis of tuberculosis but in case of tuberculous otitis media it is difficult to appreciate the classical features as the bacterial count is low in the specimen due to prolonged use of topical antibiotics.

5) Molecular genetic studies like line probe assay not only helps in the diagnosis of tuberculosis but even identifies the sensitivity to drugs isoniazid and rifampcin.

6) Tests for diagnosing tuberculosis should be repeated even if its initially negative whenever there is a strong clinical suspicion.

7) Surgery is required for tissue sampling and for clearance of the disease.