The lesion of middle ear as a variant of clinical manifestation of secondary tuberculosis, according to international scientific literature, is a rare condition. However, in terms of real clinical practice, the proportion of this pathology should not be underestimated due to the wide spread of tuberculosis infection among the population of developing countries, including the Russian Federation. One of the risk factors for the systemic spread of mycobacterial flora is a concomitant HIV infection, which often acts as an opportunistic pathological agent for tuberculosis. The treatment of such a state is always challenging because of the high aggressiveness of bacteria and the low immunological resistance of the patient. This article presents a clinical case of bilateral tuberculosis otitis media, which was a manifestation of tuberculosis infection that developed on the background of HIV infection.