With the use of high-resolution computed tomography, this retrospective clinical study evaluated the factors affecting hearing in patients who were operated on due to chronic otitis media with cholesteatoma and underwent ossiculoplasty with titanium total ossicular replacement prosthesis (TORP). Fifteen patients with postoperative hearing results of 20 dB or less air-bone gap, and thirteen patients with postoperative hearing results of 21 dB or more air-bone gap were the subjects of this study. All patients were operated on due to chronic otitis media and underwent ossiculoplasty with titanium TORP. High-Resolution Computed Tomography (HRCT) and pure-tone audiometry were performed on each patient after an average of 17 months, postoperatively. Three-dimensional oblique CT cross-sections were analyzed with Vitrea 2(A (R)) software. The presence of soft tissue in the middle ear and contact between the prosthesis head plate and the bone had an adverse effect on hearing (p < 0.05). The angle between the TORP and the oval window did not seem to affect the hearing results (p > 0.05). The study results indicate that an examination of the patients with poor postoperative hearing with HRCT may help find the possible cause and allow for the determination of the prosthesis location.