Tuberculosis affects the middle ear through three routes; aspiration of mucus through the Eustachian tube, blood borne dissemination from other tuberculous foci or direct implantation through the external auditory canal and tympanic membrane perforation [1- 3]. The incidence is thought to be more and is on the rise in the developing countries [4]. In recent years extra pulmonary tuberculosis has more frequently been associated with mastoiditis in patients with immunodeficiency state. Although tuberculosis of the mastoid or otomastoiditis is a very rare complication of tuberculosis today, when occurs it may cause significant morbidity. Complications such as facial paralysis and permanent hearing loss may develop [6]. The diagnosis of tuberculous mastoiditis is difficult and may be delayed for months to years, especially if the patient shows no other manifestations of the disease. We present a case of 28 years old man with tubaculous mastoiditis.