This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Ear, Subject name: ENT
True about tubercular otitis media are all except 
Select and explain. 
A. Spreads through Eustachian tube, B. Causes painless ear discharge, C. May cause multiple perforations, D. Usually affects both ears
D: Usually affects both ears
Answer: D: Usually affects both ears 
Explanation: Tubercular otitis media In most of the cases, infection is secondary to pulmonary tuberculosis; infection reaches the middle ear through the eustachian tube. Perforation: Multiple perforations, 2 or 3 in number, are seen in pars tensa and form a classical sign of disease. These may coalesce into a single large perforation. Painless ear discharge: Earache is characteristically absent in cases of tubercular otitis media. Discharge is often foul-smelling because of the underlying bone destruction. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 81,82)