A 12-year-old boy presented with intermittent, foul-smelling, occasionally blood-stained left ear discharge for 3 years which did not improve with conventional antibiotic therapy. He had no other features suggestive of TB such as cervical lymphadenopathy, weight loss, and night sweats. Otoendoscopic examination revealed a fleshy polyp at the posterior superior and attic area associated with thick yellowish discharge. The pars tensa of the tympanic membrane was intact (Figure 1). Computed tomography (CT) temporal bone revealed soft tissue opacity in the middle ear with the ossicular erosions and destructions. There was also soft tissue density in the mastoid region with loss of septation and dehiscence of tegmen and sigmoid plate. However, the facial nerve canal, internal acoustic meatus, cochlea, and vestibule were intact (Figure 2). The audiometric examination revealed severe mixed hearing loss. The patient underwent modified radical mastoidectomy under general anesthesia, via a postaural approach using the out-to-in technique (Figure 3(a)). Upon drilling the mastoid, a cystic lesion was encountered (Figure 3(b)). The drilling was done around the cyst; however, it got punctured during the procedure and yielded dirty turbid whitish fluid. The remaining cyst and tissues were removed and sent for histopathological evaluation. There was a sequestrum as well which was also removed. The granulation tissues at the attic were removed. Posterior bony canal wall was drilled out and canal wall down mastoidectomy was performed. The lenticular and long process of incus was necrosed and removed. The malleus head was removed to evaluate the anterior epitympanum (attic). Stapes suprastructure was partially necrosed (Figure 3(c)). Temporalis fascia graft was placed after clearing the disease. There were no postoperative issues. The cyst wall along with granulations tissues were sent for histopathological examinations (Figure 3(d)). The histopathological report showed epithelioid cell granulomas, Langerhan's type giant cell, chronic inflammatory cells, and granulation tissue, consistent with TB. The cyst wall lining epithelium was attenuated with chronic inflammatory cells infiltration and giant cell reaction (Figure 3(e)). The antitubercular medications were started for the patient, and finally, the patient recovered after completion of chemotherapy (Figure 3(f)). The patient was followed up for 1 year, the cavity healed however, the hearing did not improve.