The decreased frequency of tuberculosis, and particularly its aural manifestations, means that the disease is encountered infrequently. The diagnosis is made earlier if a high index of suspicion is maintained, particularly in the following circumstances: Onset is insidious, hearing loss is profound and multiple perforations are encountered; There is lack of response to conventional treatment; There are characteristic protruding granulations from mastoid cells at mastoidectomy; There is a history of contact with tuberculosis; There is persistent otorrhea after mastoidectomy with slow, incomplete healing or granulomatous recurrence.