Introduction: CSOM is chronic inflammatory changes of the tympanic cavity and one of the leading causes of chronic aural discharge which has potential for intracranial extension and associated middle ear complications. High-Resolution Computed Tomography (HRCT) is needed for the assessment of disease localisation, ossicular dignity, bony walls status and post-surgical assessment. Objective: To study the HRCT findings of the temporal bone in patients with CSOM and also to determine the efficacy of HRCT in patients with CSOM by comparing the preoperative findings with intraoperative findings (gold standard), whenever available. Method: Prospective observational study conducted over 14 months in 167 ears diagnosed with CSOM who underwent HRCT temporal bone, using Philips Incisive 128-slice MDCT scanner. The radiological findings were further compared with the intraoperative findings to calculate the sensitivity, specificity, negative predictive value, and positive predictive value(PPV) for diagnostic accuracy and further overall accuracy were calculated. Results: From a total of 167 ears, surgical and radiological findings showed a high level of sensitivity and specificity for location and extent of soft tissue density, ossicular status and tegmen erosion, tympanic membrane status, mastoid pneumatisation, scutum erosion with a p __ampersandsignlt; 0.01 but less sensitive for facial canal erosion. Conclusion: HRCT scan is an excellent preoperative imaging modality for the otologist to predict disease during the surgery. Early identification of complications enables a better surgical approach and treatment plan thereby making high resolution computed tomography an essential workup diagnostic tool.