<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>To compare photon-counting CT (PCCT) and multi-detector CT (MDCT) for visualization of temporal bone anatomic structures.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Thirty-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.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Substantial 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 (<jats:italic>p</jats:italic> < 0.0001), except for Arnold’s canal (<jats:italic>p</jats:italic> = 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 (<jats:italic>p</jats:italic> < 0.0001). Average (range) of DLP was 95 (79–127) mGy*cm for MDCT and 74 (50–95) mGy*cm for PCCT (<jats:italic>p</jats:italic> < 0.001).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>PCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose.</jats:p> </jats:sec><jats:sec> <jats:title>Graphical Abstract</jats:title> </jats:sec><jats:sec> <jats:title>Critical relevance statement</jats:title> <jats:p>PCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose.</jats:p> </jats:sec><jats:sec> <jats:title>Key points</jats:title> <jats:p><jats:list list-type="order"> <jats:list-item> <jats:p>PCCT allows high-resolution imaging of temporal bone structures.</jats:p> </jats:list-item> <jats:list-item> <jats:p>Compared to MDCT, the visibility of normal temporal bone structures is scored better with PCCT.</jats:p> </jats:list-item> <jats:list-item> <jats:p>PCCT allows to obtain high-quality CT images of the temporal bones at lower radiation doses than MDCT.</jats:p> </jats:list-item> </jats:list></jats:p> </jats:sec>