Middle ear adenomas are rare benign tumors, which can easily be mistaken for other conditions radiologically. They derive from the middle ear mucosa. We report the case of a 48-year-old man with a history of decreased left-sided hearing and intermittent pulsatile tinnitus. High-resolution CT of the temporal bones revealed a well-defined left middle ear soft-tissue attenuation abutting the head of the malleus. Surgical excision revealed a middle ear adenoma.