Aim: To study the radiological findings related to middle ear pathologies using X–ray mastoid schuller’s view & HRCT Temporal bone and correlation with clinical and operative findings.

Method: Prospective Cohort study of fifty patients with suspected middle ear pathologies based on clinical history & examination, subjected to bilateral X–ray mastoid schuller’s view and HRCT temporal bone.

Result: Twenty six (52%) cases were of CSOM (TTD), fourteen (28%) cases were of CSOM with cholesteatoma and ten (20%) cases were of trauma. Twenty five patients were operated. HRCT temporal bone showed 96% sensitivity in detecting disease extent, 99.3% sensitivity and 80% specificity in detecting ossicular erosion,100% sensitivity and 100% specificity for detecting scutum erosion, 91.7% sensitivity with specificity of 84.6% in detecting tegmen erosion,100% sensitivity and specificity in detecting sinus plate erosion,75% sensitivity and 82.4% specificity in detecting facial canal involvement and 66.7% sensitivity & 95.5% specificity in detecting the lateral semicircular canal erosion.

Conclusion: The present study showed a good agreement between HRCT and operative findings. HRCT temporal is a useful diagnostic tool for diagnosing, surgical planning and management of temporal bone pathologies.