Introduction: The symptomatology of tuberculosis is such that it can disguise any disease. Its presentation as primary otomastoiditis is quite rare. Clinical case: We report a rare case of tubercular otitis media in young male who presented with recurrent otorrhea, post aural fistula with CT scan revealing destruction of dural plate and underwent mastoidectomy twice. Adequate treatment was possible only after obtaining a specific diagnosis following histopathology and culture examination after second surgery. Conclusion: Although TBOM is a rare entity these days but surgeons and physicians need to be aware of this possibility especially in patients with otitis media not responding to usual treatment or in those having typical features of TBOM . Early diagnosis can only avoid unnecessary multiple surgeries but can also prevent dreaded complications of Tuberculosis OM if treated timely