Middle-ear dysfunction is a common but easily overlooked complication of HIV, and tympanometry offers an objective, low-cost means of detecting it. However, data on tympanometric evaluation for adults living with HIV in north-central Nigeria are scarce. This study determined the tympanometric patterns among HIV-positive adults attending a general hospital in Abuja and examined their relationship with clinical and demographic factors. In a hospital-based cross-sectional study, 110 consecutively recruited adults on follow-up at the HIV clinic of Kubwa General Hospital underwent a structured interview, otoscopy and tympanometry. Tympanograms were classified according to the Jerger system, with type A considered normal and types As, Ad, B, and C considered abnormal. Associations were tested with chi-square or Fisher's exact tests and with t or Mann-Whitney tests at p < 0.05. The participants had a mean age of 40.2 ± 8.7 years; 68.3% were women and 92.4% were on antiretroviral therapy. Type A accounted for 52.9% of 206 ears, and abnormal tympanograms were present in 47.1% of ears and 57.1% of patients (95% CI 47.6 to 66.2). The commonest abnormality was the reduced-compliance type As pattern (26.2% of ears), and findings were largely bilateral and symmetrical. Only 27.3% of patients reported any otological symptoms, and otoscopy showed poor agreement with tympanometry (kappa 0.218). No demographic or HIV-related variable was significantly associated with abnormality, although serious HIV-related infection showed a non-significant trend. Middle-ear dysfunction was common and largely subclinical, and tympanometry merits routine use as a screening tool in HIV care in similar resource-limited settings.