Learn pearls of reading temporal bone images and apply that knowledge to improve your surgical outcomes. This panel starts with pointers on how to consistently evaluate temporal bone CTs and lateral skull base MRIs. A checklist is provided for you to apply that systematic approach in your own practice. Next, examples of how to translate mastoid and facial recess anatomy from the images to the OR will be shown with tips for safe, efficient drilling. Finally, the panelists will discuss and debate how they use imaging to choose a surgical approach and how that imaging can affect what they do in the OR. Topics will include when imaging is warranted for chronic ear disease/cholesteatoma, applying endoscopic ear techniques to access ear disease, transmastoid verses middle fossa approaches for CSF leaks, and skull base considerations for vestibular schwannoma, meningioma, and pulsatile tinnitus approaches. Didactic presentations will be supplemented with case examples to provide tips relevant for everyone from trainees to experienced neurotologists. Improve your radiographic interpretation of the temporal bone and improve your surgical outcomes.