Background: Chronic suppurative otitis media (CSOM) may cause persistent middle-ear disease, ossicular damage and complications involving the temporal bone. High-resolution computed tomography (HRCT) provides detailed anatomical assessment and helps define disease extent before surgery. This study evaluated HRCT findings in patients with CSOM and compared imaging features between atticoantral and tubotympanic disease. Methods: This descriptive observational cross-sectional study included 70 patients with clinical features suggestive of CSOM. Participants underwent clinical and audiological assessment, including pure-tone audiometry, followed by HRCT of the temporal bone. Imaging findings related to middle-ear and mastoid opacification, ossicular involvement and bony changes were recorded. Associations between clinical type, HRCT findings and hearing loss were analysed using appropriate statistical tests. Results: In this cohort, mean age was 24.5 ± 9.4 years, and 60.0% of participants were male. Ear discharge (94.3%) and hearing loss (90.0%) were the commonest symptoms. HRCT showed soft-tissue opacification in 88.6% of patients, most frequently involving the mesotympanum (67.1%) and epitympanum (57.1%). Ossicular erosion was present in 47.1%, with the incus most commonly affected (44.3%). Scutum erosion was the most frequent bony abnormality (45.7%). Atticoantral disease showed significantly higher frequencies of soft-tissue opacification, epitympanic, antral and aditus involvement, ossicular erosion and scutum erosion than tubotympanic disease. The number of eroded ossicles was significantly associated with the degree of hearing loss (p<0.001). Conclusion: HRCT demonstrated the anatomical extent of CSOM and identified ossicular and adjacent bony abnormalities. Destructive imaging findings were more frequent in atticoantral disease, and greater ossicular involvement was associated with more severe hearing loss. HRCT is a useful adjunct for preoperative assessment an