Tuberculous mastoiditis: when is surgery indicated?

Mycobacterium tuberculosis is a rare cause of mastoiditis, but diagnosis is often delayed, with potentially serious results. We present the case of a 7-year-old child who failed to improve even once the diagnosis was made and appropriate medical treatment initiated. At mastoidectomy, a bony sequestrum was found which had not been evident on CT scanning. We review the diagnosis and management of this condition and suggest that failure to respond to drug therapy even in the absence of demonstrable complications be added to the list of indications for surgical intervention.