DOI: https://doi.org/10.36347/sasjm.2026.v12i05.035

Pages: 563-567

Middle ear tuberculosis is an uncommon but clinically significant condition that necessitates early and accurate diagnosis to prevent serious complications, including hearing loss and facial paralysis. In this case series, we present three patients diagnosed with middle ear tuberculosis and review its clinical presentation, diagnostic challenges, and management strategies. Although rare in immunocompetent individuals, the condition occurs more frequently in those with compromised immune systems. The exact mode of transmission remains unclear, but hematogenous spread or direct extension from a nearby tuberculosis focus are the most likely routes. Diagnosis is frequently delayed due to the rarity and non-specific symptoms of the disease; the most common presenting complaint is chronic otorrhea unresponsive to standard antibiotic therapy. High-resolution computed tomography (CT) is the preferred imaging modality to assess disease extent. Diagnosis typically requires a combination of clinical evaluation and paraclinical investigations. Medical treatment consists of a standard anti-tuberculosis regimen including isoniazid, rifampicin, pyrazinamide, and ethambutol for six to nine months. Surgical intervention may be necessary for diagnostic biopsy and to rule out other pathologies. Prompt and appropriate treatment can significantly reduce the risk of long-term sequelae. Increased clinical awareness is key to ensuring timely diagnosis and optimal patient outcomes.