Some of the symptoms associated with the temporal bone diseases are nonspecific, whereas others overlap with each other. Careful history and physical examination is of paramount importance for the localization of these disorders to a certain anatomic structure. Imaging plays a critical role in diagnosis, treatment planning, and follow-up of diseases of the temporal bone. This article discusses the common diseases associated with the temporal bone in a symptom-based approach. The categories reviewed are otalgia, hearing loss, tinnitus, and vertigo. Representative imaging features of the common abnormalities in each category are discussed. When a disease is associated with more than one symptom, it is included under the predominant symptom. We also provide guidelines for the preferred imaging modalities in certain clinical scenarios.