<p><strong>Background:</strong> Cholesteatoma is a serious health hazard which can give rise to alarming intracranial and extracranial complications as it can progressively enlarge and invade into neighbouring structures. Thus, early diagnosis and prompt management of a suspected cholesteatoma is necessary. High resolution computed tomography (HRCT) temporal bone scan clearly defines the extent and location of soft tissue density in middle ear with adjoining bony erosions. The aim of the study was to determine the role of HRCT temporal bone in early detection of cholesteatoma and finding the correlation between preoperative HRCT temporal bone and intraoperative surgical findings.</p><p><strong>Methods: </strong>Total 60 cases with unsafe chronic otitis media (COM) attending ENT OPD of Rajindra hospital, Patiala were selected for this prospective study. All patients were scanned for HRCT temporal bone and preoperative radiological data was correlated with intraoperative surgical findings. The results were calculated and analysed statistically.</p><p><strong>Results:</strong> This study demonstrated good correlation between preoperative temporal bone HRCT scans with intraoperative surgical findings, particularly in ossicular erosion (except stapes), LSC erosion, facial canal erosion, lateral cortical wall erosion and dural and sinus plate erosion.</p><p><strong>Conclusions: </strong>HRCT temporal bone scan evidently demarcates the soft tissue density in middle ear and mastoid with adjacent bone erosions and it also provide details of anatomical variations. Hence HRCT temporal bone is valuable in diagnosing and guiding surgical management of unsafe COM making it prerequisite before any surgical manipulation.</p>