Purpose:  This exhibit illustrates the role of 3D CT for (a) evaluating temporal bone pathology, (b) providing additional information not obtained from conventional 2D imaging, and (c) guiding appropriate surgical procedures. Approach/Methods:  High-resolution CT scans of the temporal bone were obtained in 134 patients with complaints related to the auditory apparatus in the axial (inferior orbito-meatal) plane using a 16-slice spiral CT (Somatom Sensation 16, Siemens Medical Solutions, Malvern, PA, USA), 120 kv, 200 mAs and overlapping 0.7 mm thick sections reconstructed at 0.1 mm intervals.  The axial data sets were post-processed on Terarecon (Aquarius Workstation, V 3.3, San Mateo, CA) to provide both 3D projections and special oblique planes designed to display specific structural relationships.  Findings: The 3D-CT reconstructions can be generated from the source images rapidly (< 10 minutes) by either a Fellow or a post-processing technologist. These images successfully display the pathology, and the related surgically-significant anatomy, in fine detail. Reconstructing the temporal bone along selected oblique planes, in circumferential “rotational” 360° views, is especially beneficial for laying out all of the related pathology. This technique has proved extremely useful for demonstrating the specific derangements of congenital anomalies, such as absent oval window, or anomalous bands of soft tissue that tether the malleus to an aberrant internal carotid artery. 3D CT also demonstrates the extent of erosion of the ossicles by cholesteatoma, and the full extent of fracture lines that course through the temporal bone. Our case material documents that the 3D CT reformations contribute meaningfully to proper surgical planning, and may display definitively pathology that appears equivocal on the serial axial/coronal images. Conclusion:  3D CT images can be rapidly reconstructed, sectioned in any plane, and rotated in space to demonstrate temporal bone pathology most effectively.  They provide information complementary to conventional 2D imaging, helping us better define underlying pathology.  The additional information gained aids in surgical planning.