Objective To investigate the clinical manifestations, diagnostic strategies and clinical treatment of infantile tuberculous otitis media.Methods The clinical data of 3 children with tuberculous otitis media admitted to our hospital from April 2021 to January 2025 were retrospectively reviewed. Among them, there were 2 boys and 1 girl, with an average age of (5.67 ± 2.05) months. After antibiotic treatment, the therapeutic effect was unsatisfactory. Relevant blood routine, ear discharge culture, mastoid CT and MRI examinations were completed. Modified mastoidectomy and external auditory canal granulation tissue removal surgery were performed at an appropriate time. Antibiotics were adjusted according to the results of bacteriological examination. The children were discharged after their symptoms were stable and followed up regularly. Results Before surgery, all 3 children showed recurrent ear discharge and granulation tissue hyperplasia in the external auditory canal. Among them, 2 children had pulmonary tuberculosis infection before surgery. The ear discharge culture results of 2 children before surgery indicated positive methicillin-resistant Staphylococcus aureus (MRSA), and linezolid was selected for anti-infection treatment based on the drug sensitivity test. Mastoid CT before surgery showed mastoiditis with partial bone destruction in the middle ear; MRI before surgery showed mass-like signals in the mastoid and external auditory canal, with long T1 and long T2, and fat-suppressed T2 signals. Intraoperative pathology showed chronic granulomatous inflammation with caseous necrosis. Two children were transferred to a specialized infectious disease hospital for further treatment after surgery, and 1 child was discharged after surgery and received follow-up observation by taking linezolid orally.Conclusion Tuberculous otitis media in infants and young children occurs relatively insidiously, often complicated with multi-drug resistant bacterial infections, and has poor response to traditional antibiotic treatment. Mastoid CT and MRI should be completed in a timely manner, and mastoidectomy should be performed to remove the lesion. The diagnosis should be confirmed based on bacteriological and pathological examinations after surgery, and anti-tuberculosis drugs should be adjusted. Regular follow-up should be conducted after surgery to monitor the recovery of mastoid lesions.