The purpose of this study was to determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management. Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients.