A total of nine cases were included over a period of 8 months. Their demographic and clinical details are described in Table 1. Eight patients were adults with an age range from 25 to 85 years and one patient was a 6-year-old child. Seven patients were male and two were female. Two patients had co-morbid conditions; one was on anti-retroviral treatment and the other had diabetes mellitus with hypertension. Patients presented with atypical symptoms such as discharging sinus, ear lobule swelling, otitis media, vision loss and facial weakness, long refractory otorrhoea and granulation tissue in the ear canal. One patient had complained of right vision loss, proptosis and headache for 6 months. One of these nine patients had coexistent pulmonary tuberculosis. None of the patients had a significant past or family history. All patients were suffering for a long span of time and were non-responsive to broad-spectrum antibiotics. External auditory canal, laryngoscopy and audiometry examination showed atypical features that were consistent with tuberculosis or neoplasms. Radiological investigations showed typical features of osteomyelitis of the temporal bone and skull base, and others, such as destruction of bone, increased bone uptake and densities, which needed further evaluation (Table 2, Fig. 1). Histopathological evaluation revealed granuloma in few cases and atypical features in some, suggesting neoplasm. We were able to diagnose involvement of the temporal bone (two cases), tubercular skull base osteomyelitis (one case), mastoid bone (one cases), larynx (two case), sino-nasal (one case), maxillary sinus (1one cases) and ear lobule (one case). Microbiological examination of samples confirmed the cases (Table 2). All samples were acid-fast bacilli-positive (ZN staining), while GeneXpert was positive in four cases for MTB and TrueNat was positive in all nine cases and detected MTB (four cases) and NTM) (five cases (Table 2). All patients were managed successfully with a combination of surgical and combination regimens including antibiotics (NTM cases) and anti-tubercular drugs, except one tubercular skull base osteomyelitis patient, who expired before the initiation of anti-tubercular therapy (ATT) (Table 3).