Successful surgery of the temporal bone presumes an outstanding knowledge of the radiologic microanatomy of the surgical field.

For most otologic surgery, the first procedure offers the only opportunity for a good result and revision operations are fraught with complications. Preoperative high-resolution computed tomography (HRCT) affords the surgeon the best opportunity to both evaluate the anatomy and pathology and plan the optimal procedure for the initial surgery.

A rhinologist will not consider nasal surgery without a CT scan of the nose and paranasal cavities. Why should the otologist operate on one of the most delicate sensory organs without taking advantage of modern imaging technology?

Failure to appreciate and utilize the wealth of information provided by preoperative CT scans can only be explained as a lack of recognition of the variability and complexity of the anatomy of the temporal bone.

Omission of HRCT to reduce treatment expenses may be imprudent in view of the precious sensory organs that reside within the temporal bone.

Do not overlook the fact that a loss of hearing or vestibular function and/or a lesion of the facial nerve will cost considerably more than a preoperative HRCT scan.

Keep in mind that many radiologists have never set foot in the operating room and therefore are unaware of the details of the operative site that are of special relevance to the surgeon.

The regular interaction between radiologist and otologist leads to a better understanding of their reciprocal needs and improves their skills in interpreting temporal bone images.

HRCT scans should be available for the precise preoperative evaluation of all patients requiring extensive and/or delicate surgery of the temporal bone.

The otologist should be able to read HRCT scans as well as—if not better than—the radiologist. Therefore, make your own radiologic diagnosis before you read the report of the radiologist.

Do not make any diagnostic or therapeutic decisions based upon technically poor or inadequate CT scans.

The otologist should recognize the limitations of clinical impressions and learn to integrate the information given by modern imaging techniques into his or her diagnostic skills.

HRCT helps in detecting possible intraoperative difficulties and complications.

The clinical importance of HRCT is similar to that of facial nerve monitoring; once you have recognized its value you will not feel comfortable operating without it.

The systematic use of HRCT (conventional and multiplanar reconstructions) is an essential step for adequate planning of surgery and for the precise evaluation of postoperative results.

During the surgical procedures, the patient’s HRCT (and audiogram) has to be visible to the surgeon in the operating room. Its mere presence in the patient’s records is not sufficient.

The decision for an open or closed cavity is based on the extent of pneumatization and on the patency of the tympanic ostium of the eustachian tube as seen on preoperative CT scans.