Chronic otitis media requires precise preoperative evaluation to determine disease extent, complications, and anatomical variations. This study assessed the reliability of HRCT temporal bone in patients undergoing surgery. HRCT showed 100% sensitivity and specificity for scutum and malleus erosion, mastoiditis, and mastoid abscess. Cholesteatoma detection sensitivity exceeded 80% across middle ear and mastoid regions. Facial canal dehiscence and tegmen erosion demonstrated 100% specificity but variable sensitivity. HRCT is a reliable tool for preoperative evaluation, though further population-based studies with longer follow-ups are recommended.