X-rays and CT are both imaging techniques that use the differences in absorption produced by different densities of tissue when X-rays penetrate the human body to reveal information about the internal anatomical structures of the human body, but the former is like using a hydraulic press to compress all the anatomical structures into a flat photograph, while the latter is like using a blade to cut the human body into slices like bread for layer-by-layer observation. The middle ear is located inside the temporal bone and has a complex anatomy and fine structure, and the images are mostly blurred during the radiographs because the tissues overlap each other, so the traditional X-ray examination is poor in discriminating the fine structures of the middle ear and cannot show and distinguish the tiny lesions in the middle ear. since the 1970s, modern imaging techniques have emerged, which have greatly helped in the quantitative and qualitative diagnosis of middle and inner ear diseases. In fact, in today’s medical practice, plain ear x-rays have been largely eliminated by CT. In general, a middle ear mastoid x-ray shows the external auditory canal, superior tympanic chamber, tympanic canopy, mastoid process, and sigmoid sinus plate. By observing the changes in the above structures during otitis media, the type of otitis media can be judged, such as the presence or absence of larger cholesteatoma formation, and the presence or absence of bone destruction in the sigmoid sinus plate and tympanic cavity canopy; a rough judgment can be made about the location of the vascular nerves in the middle ear mastoid. In small and medium-sized hospitals that do not have the conditions, X-ray middle ear mastoid films are still of great clinical value and are relatively inexpensive, and can also be used as an outpatient screening method for cholesteatoma formation. CT examination is more expensive, but high-resolution CT of the temporal bone can not only clearly show the middle ear auditory tuberosity, facial nerve, tympanic cap, sigmoid sinus and other adjacent important structures, and can accurately locate the tiny cholesteatoma or granuloma lesions in the middle ear, but also show the destruction of the surrounding bone, the degree of hearing bone chain loss, early prediction of intracranial complications, and estimation of the difficulty of surgery, which can help doctors choose the surgical method. It is very helpful and has very obvious superiority.