<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) is characterized by ear discharge and hearing loss. There are two types of COM depending on the presence or absence of cholesteatoma. COM with cholesteatoma is termed as COM squamosal type and COM without cholesteatoma is termed COM mucosal type. COM squamosal type is associated with potential complications. If cholesteatoma is detected early, less invasive surgical methods can be used for hearing preservation and make ear safe from recurrent infections. A proper clinical examination can most often diagnose a cholesteatoma but require a high resolution computed tomography (HRCT) scan to assess the extent of the disease and potential complications. But most often the intra operative findings may not correlate with the HRCT findings. The aim of the study was to evaluate the clinical presentation of COM squamosal disease, preoperative HRCT and intra-operative findings and formulate a proper surgical intervention to avoid complications. </p><p class="abstract"><strong>Methods:</strong> This is a comparative study of the pre-operative HRCT and intra-operative findings in COM squamosal type. In the present study of 35 patients with squamosal disease, the HRCT findings were compared with intra-operative findings.</p><p class="abstract"><strong>Results:</strong> The study showed a good correlation between pre-operative HRCT of temporal bone and intra operative finding. The findings are statistically significant (p<0.001).</p><p class="abstract"><strong>Conclusions:</strong> The study shows a good correlation between pre-operative HRCT temporal bone and intra-operative findings.</p>