Tuberculosis (TB) is an important re-emerging disease with increasing global morbidity and mortality. Pulmonary involvement is the commonest form of TB and otorhinolaryngologic (ORL) manifestations are common presentations in patients with pulmonary TB (PTB). To evaluate the prevalence of ORL lesions and their effects in these patients this study was prospectively designed. One hundred consecutive patients with newly diagnosed PTB were enrolled for the study. All patients were subjected to a protocol for the diagnosis of  PTB (which included thorough history taking, complete systemic and local chest examination, complete blood picture, erythrocyte sedimentation rate, chest x-ray and sputum direct smear examination and culture for acid-fast bacilli) and ORL assessment (which included full history taking, auditory perceptual assessment, ENT and head and neck examination, videostroboscopic evaluation, sinoscpic evaluation, acoustic analysis and aerodynamic evaluation). All the biopsy specimens taken from ORL lesions were examined histopathologically. Out of 100 patients included in the study, 70% had sputum-positive PTB and 30% had sputum-negative PTB.  Otorhinolaryngologic lesions were detected in 54.3% of patients with sputum-positive PTB and 30% of patients with sputum-negative PTB (p=0.02). Single lesions were detected 87.2% of patients with ORL lesions while multiple lesions were detected in 12.8% (p=<0.0001). Histopathological examination of biopsy specimens obtained from these lesions revealed TB granuloma in all cases. All patients included in the study had chest radiographic abnormalities. Otorhinolaryngologic lesions were significantly commoner in patients with far advanced and moderately advanced radiographic lesions than in those with minimal lesions (p=0.006 and 0.01 respectively). Laryngeal lesions were the commonest ORL manifestations and were found in 35% of patients with PTB (p=0.0001). They were found in 74.5% of patients with ORL lesions (p=<0.0001) of them 82.9% had sputum-positive PTB and 17.1% had sputum-negative PTB (p=<0.0001). The vocal folds, ventricles, posterior glottis and epiglottis were the laryngeal areas most commonly affected by TB. Dysphonia and phonasthenia occurred in all cases with laryngeal involvement. In patients with laryngeal TB, acoustic analyses revealed a change from normal in the form of highly increased parameters for both vowel and connected speech and most of the aerodynamic measurements were lower than normal. Pharyngeal involvement was detected in 10% of patients with PTB. It was found in 21.3% of patients with ORL lesions of them 70% had sputum-positive PTB and 30% had sputum-negative PTB (p=0.1). Tuberculous cervical lymphadenitis was found in 6% of patients with PTB while nasal TB was detected in 3%. From this study it can be concluded that the classical manifestations of ORL-TB are not always existed and the otorhinolaryngology is involved with variable prevalence in both sputum-positive and sputum-negative PTB. Otorhinolaryngologic lesions could aid in confirming the diagnosis of sputum negative PTB by detecting TB granuloma on histopathological examination of biopsy specimens. The larynx is the most commonly affected site and both the acoustic and aerodynamic parameters are affected in patients with TB laryngitis. These measurements could be used as prognostic indicator for successful treatment.