During the past few decades the clinical features of middle ear tuberculosis have changed. Hence, clinical differentiation between tuberculous and non-specific proliferative otitis media and mastoiditis is now difficult. Between 1986 and 1992 five cases of tuberculous otitis media were treated surgically in the ENT-Dept. of the University of Hamburg, representing 0.2% of all performed middle ear operations. According to our experience the therapy of choice is the open mastoid cavity with subsequent chemotherapy to avoid recurrent infections. The advantages of this procedure are proven by actual histopathological findings as well as by the analysis of historical microsections of the Wittmaack temporal bone collection: according to these findings, two different types of histopathological alterations can be differentiated.