PurposeTo compare photon-counting CT (PCCT) and multi-detector CT (MDCT) for visualization of temporal bone anatomic structures.MethodsThirty-six exams of temporal bones without pathology were collected from consecutive patients on a MDCT, and another 35 exams on a PCCT scanner. Two radiologists independently scored visibility of 14 structures for the MDCT and PCCT dataset, using a 5-point Likert scale, with a 2-month wash-out period. For MDCT, the acquisition parameters were: 110 kV, 64 × 0.6 mm (slice thickness reconstructed to 0.4 mm), pitch 0.85, quality ref. mAs 150, and 1 s rotation time; for PCCT: 120 kV, 144 × 0.2 mm, pitch 0.35, IQ level 75, and 0.5 s rotation time. Patient doses were reported as dose length product values (DLP). Statistical analysis was done using the Mann–Whitney U test, visual grading characteristic (VGC) analysis, and ordinal regression.ResultsSubstantial agreement was found between readers (intraclass correlation coefficient 0.63 and 0.52 for MDCT and PCCT, resp.). All structures were scored higher for PCCT (p< 0.0001), except for Arnold’s canal (p= 0.12). The area under the VGC curve was 0.76 (95% CI, 0.73–0.79), indicating a significantly better visualization on PCCT. Ordinal regression showed the odds for better visualization are 354 times higher (95% CI, 75–1673) in PCCT (p< 0.0001). Average (range) of DLP was 95 (79–127) mGy*cm for MDCT and 74 (50–95) mGy*cm for PCCT (p< 0.001).ConclusionPCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose.Graphical AbstractCritical relevance statementPCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose.Key pointsPCCT allows high-resolution imaging of temporal bone structures.Compared to MDCT, the visibility of normal temporal bone structures is scored better with PCCT.PCCT allows to obtain high-quality CT images of the temporal bones at lower radiation doses than MDCT.