Background: Mycobacterium tuberculosis is a rare cause of mastoiditis, but diagnosis is often delayed, with potentially serious results.

Case: We report a case of tuberculous mastoiditis with unilateral hearing loss, facial paralysis, and cervical lymph adenopathy on presentation.                        

Conclusion: Tuberculous mastoiditis must be considered in all cases of chronic refractory mastoiditis especially in the presence of demonstrable complications such as facial paralysis, other cranial nerve palsies, and destruction of middle ear osscicles.