<p class="abstract"><strong>Background:</strong> Aim was to study the correlation between high resolution computed tomography (HRCT) scan and intraoperative findings during surgery in cases of chronic otitis media with cholesteatoma.</p><p class="abstract"><strong>Methods:</strong> This was a descriptive study conducted on 72 patients with acquired cholesteatoma at Govt TD Medical College, Alappuzha for a period of 18 months. All the patients were subjected to HRCT of the temporal bone. Radiological correlation was done with the intra-operative findings. Sensitivity, specificity, positive and negative predictive values were calculated.   </p><p class="abstract"><strong>Results:</strong> Total 24 (33.3%) patients had holotympanic cholesteatoma, 21 (29.2%) had involvement of the attic alone and 16 (22.2%) had attic and antrum involved. 100% correlation was found with bony wall erosions, whereas 96.9% and 75% sensitivity were noted in incus and stapes erosions respectively. 100% specificity was obtained in facial canal and sinus plate erosion, while a specificity of 96.9% in tegmen erosion and 98% in were seen in malleus erosion. By chi square test the difference in correlation was not significant (p value&gt;0.01). Good correlation was seen for lateral semicircular canal fistula. Contrast CT is more specific, but MRI with diffusion weighted sequences is the best in imaging cholesteatoma, especially residual lesions.  </p><p class="abstract"><strong>Conclusions:</strong> Good correlation was found between HRCT scan and intra-operative findings in cases of cholesteatoma in relation to bony wall erosion of the surrounding structures. CT scan alone cannot differentiate soft tissue masses.</p>