Tubercular otitis media produces characteristic discharge, tympanic membrane changes and hearing loss; facial paralysis may also occur.
Discharge and perforations
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Earache is characteristically absent. Discharge is often foul-smelling because of underlying bone destruction.
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Two or three perforations in pars tensa form a classical sign. They may coalesce into a single large perforation, making the appearance indistinguishable from nonspecific chronic suppurative otitis media.
Hearing loss and facial paralysis
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Hearing loss is severe and out of proportion to symptoms. It is mostly conductive, with a possible sensorineural component from labyrinth involvement.
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Facial paralysis is a common complication that may occur unexpectedly and may be the presenting feature in a child.