Summary During the period 1950–1959, 12 cases of tuberculous otitis media have been seen at the Royal National Throat, Nose and Ear Hospital, London. The majority of the patients were children or young adults. Three patients gave a previous history of non-pulmonary tuberculosis; 4 were found to have radiographic evidence of past or present pulmonary tuberculosis; in the remaining 5, the infection appeared to be confined to the ear. There was wide variation in the mode of presentation of the disease. Some patients presented as cases of acute otitis media, while others complained only of painless otorrhoea which had been present for months or even years. In general, the chronic cases occurred amongst patients who showed evidence of past or present tuberculosis in other sites, while in the more acute cases the infection was often confined to the ear. In the absence of a known history of tuberculosis, clinical diagnosis may be extremely difficult. The value of routine histological examination of material removed at operation for middle ear infections is therefore emphasized. A case could perhaps also be made out for the examination of the aural discharge for the presence of Myco. tuberculosis when cases of otitis media do not respond readily to ordinary methods of treatment.