Successful temporal bone imaging demands appropriate modifications of the computed tomography (CT) scanner. While CT has been shown to be useful for demonstrating the detailed anatomy of the temporal bone, its role in the evaluation of middle ear pathology has not been investigated. Selective cases are presented to highlight the advantages of CT. Computed tomography is excellent in demonstrating soft tissue masses in the middle ear in inflammatory disease. It is also useful in accurately localizing bony fragments in trauma, as well as determining the status of the ossicles. Disease solely involving the tympanic membrane can be diagnosed on CT without subjecting the patient to surgical exploration.