BACKGROUNDHigh resolution computerized tomography (HRCT) is valuable for detection of early erosive changes suggestive of cholesteatoma. The aim of our study was to determine characteristic CT findings in patients with middle ear cholesteatoma.METHODSWe conducted a retrospective review of CT scans and surgical and histopathological reports in 64 patients with middle ear cholesteatoma (35 male, 29 female; age range, 7–80 years, median age, 22 years). CT scans were evaluated for the presence of intra-tympanic non-dependent soft tissue density, the extent of middle ear involvement, bone expansion and thinning, and bone erosions involving the ossicles and adjacent structures.RESULTSMiddle ear cholesteatoma was more common in male patients and in patients aged 20–35 years. All patients had soft tissue density in the middle ear. Fifty-nine (92%) had expansion of the aditus and mastoid antrum, 59 (92%) had erosions of the ossicles, with involvement of the long process of the incus in 48 (75%), 55 (86%) had an eroded scutum, 55 (86%) an eroded facial nerve canal, 57 (89%) an eroded Koerner’s septum, which was totally destroyed in 19 (27%), 48 (75%) had tegmen erosion, and 63 (98%) had erosions of the antral walls. The correlation of pre-operative CT with surgical and histopathological findings was 97%.CONCLUSIONMiddle ear cholesteatoma is a distinct clinical entity with characteristic findings that may be suggested by CT imaging. These findings should alert the clinician to the possibility of cholesteatoma, which will guide in the surgical approach and treatment plan.