Objective To explore the high-resolution CT manifestation of chronic otitis media with cholesteatoma. Methods clinical and high-resolution CT manifestation of 31 cases of chronic otitis media with cholesteatoma were analyzed. All the cases were confirmed by operation and pathology. Results High-resolution CT can accurately show the signs of soft-tissue occupancy and bony-erosion of cholestcatoma in middle ear which originate from various sites and of various sizes.confirmed by operation, accuracy were as high as 93.5%-100% . Conclusion high-resolution CT is extremely accurate in diagnosis of chronic otitis media with cholesteatoma.