Diagnostic Challenges of Tuberculous Meningitis Initially Presenting as Otomastoiditis.

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains a major global health problem, with one-third of the world's population infected. Objective: This report presents five cases of tuberculous meningitis with a particular emphasis on the symptoms and signs of otitis media that, in various combinations, should raise suspicion for tuberculous meningitis. Case presentation: These cases underscore the diagnostic challenges and clinical complexities associated with tuberculous otitis media, particularly when there is concurrent involvement of the central nervous system. It is crucial for physicians to maintain a high index of suspicion for tuberculosis in patients exhibiting chronic otorrhea that does not respond to conventional treatments, especially in endemic regions or in the presence of systemic symptoms. The use of advanced diagnostic tools and a multidisciplinary approach is essential for achieving timely diagnosis and effective management. Early initiation of antituberculous therapy, coupled with surgical interventions when warranted, can lead to favorable clinical outcomes. However, it is important to note that some patients may experience long-term sequelae, which highlights the necessity for prompt diagnosis and treatment to improve prognosis in those presenting with otitis media. Conclusion: The findings of this case series contribute to a better understanding of the relationship between otitis media and tuberculous meningitis, advocating for increased awareness among healthcare providers to facilitate early recognition and intervention.