Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear, which can easily be confused with other chronic middle ear conditions. The classical features of the disease have been changing in recent years. Unusual features such as otalgia, bilateral ear involvement, single perforation on tympanic membrane and absence of facial nerve palsy also should alert the physician for early diagnosis. Knowledge of this disease is important because early diagnosis and therapy may prevent or limit complications and needless surgery. To increase awareness of this condition, we describe one case of TOM and we review the literature.