INTRODUCTION TB remained the most common cause of death from a single infectious pathogen. In 2019, an estimated 10.0 million people developed TB disease worldwide, with estimated 1.2 million TB deaths. 88% of people infected with TB were adults and 12 % were children. According to WHO, Southeast Asia reigns first with the greatest number of reported TB cases. Extrapulmonary TB constitutes about 15% of the total disease burden, in which central nervous system (CNS) TB accounts for approximately 10% of all cases and carries the highest mortality. Laryngitis and otitis media remain the most frequent ear, nose and throat (ENT) diseases of tuberculous origin. Tuberculous otitis media and tuberculous mastoiditis, when occurred together as a single disease process are referred to as tuberculous otomastoiditis (TOM). TOM is a rare entity accounting for 0.05%–0.9% of chronic middle ear infections.4 CASE DESCRIPTION Tuberculous (TB) infection still poses major global public health challenge. Disseminated TB involving multiple organs is particularly rare and often diagnosed late. We are reporting a case of TB oto-mastoiditis complicated with ipsilateral multiloculated brain abscesses and laryngeal tuberculosis, possibly following reactivation of latent pulmonary TB in an immunocompetent 21 year old male. Radiological assessments revealed bizarre and destructive nature of the disease despite benign clinical presentations of chronic discharging ear and progressive hearing loss and tolerable headache. The diagnosis of disseminated tuberculosis was made based on intra-operative findings, supported by the histopathological and microbiological results. This case is particularly interesting in view of patient’s excellent general condition despite the disseminated nature of his TB infection, 20 years after his initial exposure to pulmonary TB infection. LEARNING POINT/ CONCLUSION A full-blown disseminated TB in an immunocompetent young adult who had completed the required vaccination is a rare entity. Non-resolving otorrhea with presence of aural polyp, which did not respond to standard treatment warrant further assessments, particularly when it is coupled with complication such as hearing loss. As TB infection remains prevalent especially in this part of the world, the diagnosis of TOM should always be in the list of possible diagnosis in a chronically discharging ear. High clinical suspicion and early HRCT will expedite delivery of treatment, thus improve prognosis. In some cases, surgical intervention is needed to obtain tissue for diagnosis, remove the sequestrum and when there is clinical evidence of complications.