A Case of Tuberculous Otitis Media Diagnosed Before Surgery and Treated Successfully With Anti-Tuberculosis Medication

Tuberculous otitis media (TOM) is a rare form of chronic otitis media that often exhibits atypical characteristics and is challenging to diagnose. We report the case of a 35-year-old man with 6 months of persistent otorrhea, aural fullness, and hearing loss that did not respond to antibiotic treatment. Otoscopy showed a thickened and retracted tympanic membrane without perforation, and temporal bone computed tomography revealed soft tissue density in the middle ear and mastoid. Although the middle ear biopsy was inconclusive, pulmonary lesions were detected on chest imaging, and <i>Mycobacterium tuberculosis</i> was confirmed by polymerase chain reaction from bronchoalveolar lavage. The patient was diagnosed with TOM associated with pulmonary tuberculosis and treated with standard anti-tuberculosis medication, resulting in resolution of otorrhea, improvement of hearing, and no recurrence at 18 months. This case highlights the importance of considering TOM in refractory otitis media and shows that early suspicion can enable successful medical treatment without surgery.