TUBERCULAR OTITIS MEDIA In most of the cases, infection is secondary to pulmonary tuberculosis; infection reaches the middle ear through eustachian tube. Disease is mostly seen in children and young adults. PATHOLOGY The process is slow and insidious. Tubercles appear in the submucosal layers of middle ear cleft and caseate. There is painless necrosis of tympanic membrane. Multiple perforations may form which coalesce to form a single large perforation. Middle ear and mastoid get filled with pale granulations. Caries of bone and ossicles may occur leading to complications. Mastoiditis, facial paralysis, postauricular fistula, osteomyelitis with the formation of bony sequestra and profound hearing loss are often seen in these cases. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 74