D

Tuberculous otitis media classically produces several discrete, small tympanic-membrane perforations that may later coalesce; this “multiple perforations” pattern distinguishes it from the single large marginal, attic, or central perforations seen in other chronic ear diseases [Lucente et al., 1978, PMID 672345; Yadav et al., 2024, PMID 38313765].