The goal of th study is to evaluate the role of high‑resolution computed tomography (HRCT) temporal bone in patients with active squamosal chronic otitis media (COM). 30 patients with active squamosal COM underwent preoperative HRCT temporal bone followed by surgery. Their intra‑operative findings were compared and correlated with the radiological findings, to calculate the predictive value of HRCT temporal bone. According to the present study, HRCT was highly sensitive for detecting mastoid pneumatization, soft tissue extension, ossicular erosion, tegmen and sigmoid sinus erosion, and less sensitive for fallopian canal erosion and lateral sinus fistula. It was specific for all these parameters.The present study concludes that HRCT can be recommended not only in cases suspected with potential complications but also in all cases of COM to know the extent of disease, varied pneumatization, and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.