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Aim: To determine the extent of cholesteatoma by imaging and intraoperative findings in both pediatric and adult category. Objectives: To study the extent of disease (cholesteatoma); (a) Radiologically (HRCT-Temporal Bone) and (b) Intraoperatively, to study the post-op hearing outcome and to study the healing period (dry cavity/ epithelization of cavity) following surgery in pediatric and adult category. Materials and Method: A prospective observational study was conducted on 60 patients of chronic otitis media with cholesteatoma. Each category had 30 patients, all of which were subjected to thorough preoperative clinical examination and HRCT temporal bone scans. The scans were evaluated with the help of Lynrah et al. grading for the radiological extension of disease. The same grading system was applied for the intraoperative extension of disease. All the patients were scrutinized for upto 6 months for the follow up of mastoid cavity epithelisation and post operative hearing gain results. Results: The majority of the patients in both the categories had Grade II disease extension, illustrated in their radiological as well as intraoperative findings signifying an excellent correlation amongst the two. The epithelization of mastoid cavity postoperatively was delayed in pediatric group due to presence of huge voluminous mastoid pneumatisation. The postoperative hearing gain results were good in both the categories. Conclusion: It was concluded that limited extension of disease with early diagnosis and timely intervention in pediatric group could result in favorable prognosis in terms of healing of mastoid cavity postoperatively and hearing gain results. [ABSTRACT FROM AUTHOR]