Photon-counting CT (PCT) allows for improved spatial and contrast resolution compared with traditional energy-integrating detector CT. PCT offers markedly improved visualization of previously described structures, as well as those that were previously beyond the resolution of imaging. Although the anatomic details of the external ear and middle ear structures have been described previously, the rich detail of these structures has not been comprehensively reviewed in the radiology literature. The microarchitecture of the middle ear ossicles and bony protuberances are particularly well visualized on PCT. This review updates the existing literature with a detailed anatomic review of the external ear and the middle ear on temporal bone CT.