Background Nasopharyngeal tuberculosis constitutes 1% of the head and neck manifestation of extra-pulmonary tuberculosis. The rarity of the disease along with its non-specific presentation may pose a challenge in diagnosis. Case presentation We present a case of a 33-year-old patient who presented with a gradual onset of unilateral hearing loss. Endoscopic examination revealed leukoplakic lesions over the bilateral torus tubarius with audiological assessment revealing a mixed hearing loss in the left ear. Patient completed a 6-month course of anti-tuberculous therapy with a complete resolution of nasopharyngeal lesions and hearing loss. Conclusion We hypothesize that tuberculosis of the nasopharynx may not only lead to impaired middle ear ventilation but also damage to the ossicular chain and inner ear structures.