Background: Middle ear pathology encompasses a range of conditions such as chronic otitis media, cholesteatoma, and ossicular chain abnormalities, which, if left untreated, can lead to serious complications including hearing loss, facial nerve palsy, labyrinthine fistula, and intracranial extension. High-resolution computed tomography (HRCT) of the temporal bone plays a crucial role in the detailed evaluation of middle ear structures and in the early identification and characterization of these complications. HRCT provides excellent spatial resolution, allowing accurate assessment of bony erosions, ossicular integrity, and involvement of adjacent structures. These imaging findings are vital in guiding otologic surgeons for optimal treatment planning and surgical intervention.