Chronic suppurative otitis media (CSOM) is a common pathology in the practice of an otolaryngologist. Modern conservative therapy and surgical correction methods have made it possible to achieve good functional results. However, in some cases, standard treatment is ineffective, then such a course of CSOM is usually called ”atypical”. Under its mask, a number of systemic diseases may be hidden, which are accompanied by inflammatory changes in the cavities of the middle ear. The article describes a clinical case of ”atypical” bilateral purulent otitis media in a female patient. During surgical treatment, morphological features were noted indicating a possible specific nature of inflammation in the middle ear. During further examination by a phthisiatrician, a tuberculoma of the right lung was detected, chemotherapy was started, during which, after 4 months, the symptoms of exacerbation of CSOM were stopped. Thus, an interdisciplinary approach is necessary for diagnosis and correct tactics of management of patients with ”atypical” sluggish CSOM.