A 42 y/o female presented with a 7-month persistent right ear fullness associated with tinnitus, later developed whitish-yellowish mucoid ear discharge accompanied with a draining pre-auricular abscess and matted mass at the right neck levels II-III, 5 months in the interim. Chest radiograph revealed right basal pneumonitis while neck CT scan showed ill-defined soft mass in the right nasopharyngeal area, effacing the right Rosenmüller fossa. Nasopharyngeal biopsy revealed chronic caseating granulomatous inflammation consistent with tuberculosis, TB. But GeneXpert MTB was negative. Multidisciplinary evaluation led to the diagnoses of TB of the lymph nodes and nasopharynx and suspected TB otitis. Attendings started Anti-Kochs’ medication, leading to the gradual improvement of symptoms and eventual subjective disappearance of tinnitus. TB can occur in multi-anatomical sites: nasopharynx, cervical lymph nodes, and ears, synchronous or simultaneous. It leads to complex presentations with multifocal involvement warranting multidisciplinary approach. This stresses the importance of diagnosis guided clinical judgment in initiating treatment, especially in countries where TB is endemic.