Bilateral otomastoid tuberculosis with pulmonary tuberculosis in immunocompetent young patient

Tuberculous (TB) otitis media is rare and usually seen secondary to pulmonary tuberculosis or associated with it. TB is one of the major infectious diseases with predominant involvement of lung and lymph nodes which is common in Malaysia. Regarding the tubercular otitis media or tubercular mastoiditis, Mycobacterium tuberculosis is the principal causative agent, however, other atypical agents such as Mycobacterium bovis, Mycobacterium avium and Mycobacterium fortiutum are also responsible. TB otitis media may present with other middle ear problems whereby clinicians also unfamiliar with its typical presentation. Diagnosis is difficult because it needs specific culture and pathologic studies. Early diagnosis and effective treatment may prevent ear damage as well as central nervous system complication. The objective of this study was to report a rare case of bilateral TB otitis media to alert physicians to the rare presentation of the disease as well as to discuss the diagnosis and management plan based on the literature review.