The clinical picture of tuberculous otitis media has changed since previously documented. In our series of 31 patients, it was found that severe conductive hearing loss, abundant pale granulations, and denuded malleus handle are constant findings and, in our opinion, are significant clinical features of the pathology. The disease can also manifest itself as an acute mastoiditis. As regards to investigations, bacteriology is considered as being unreliable. This is attributed to secondary organisms interfering with the growth of the tubercle bacillus, as well as the fastidious nature of the bacillus itself. We regard histology as the most reliable means of attaining a definitive diagnosis. Treatment was with a four drug antituberculous regime administered over 6 months. Streptomycin was excluded in all but one case due to its ototoxicity. We believe TB otitis media to be secondary to an established chronic otitis media in the majority of cases.