WHO recommends bacteriological confirmation of pulmonary tuberculosis (PTB) by the detection of acid?fast bacilli (AFB) in respiratory specimens. However about 40?60% of patients with PTB suspected clinically or radiologically may fail to produce sputum, or when it is available, AFB may be negative on repeated smear examination. These sputum smear negative patients and those who fail to produce any sputum can be diagnosed by flexible fiberoptic bronchoscopy (FOB). Our study was an attempt to analyze the role of FOB in sputum smear negative PTB patients with respect to their association with clinical and radiological profile.In this prospective, open label, observational study, 40 cases of sputum smear negative PTB were subjected to bronchoscopic examination after taking informed consent and samples like bronchial aspirate, bronchoalveolar lavage and post bronchoscopy sputum were collected. Out of the total 40 patients, overall diagnosis was confirmed in 24 (60%) patients. Of these 24 patients, 17 patients were confirmed for PTB whereas 7 had other diagnoses. The study concludes that FOB is a useful tool in diagnosing sputum smear negative PTB patients even at an early stage.