Background: The use of diffusion-weighted (DW) sequences to distinguish recurrent cholesteatoma from chronic otitis media with granulations has shown to be quite effective. The differential in water molecule diffusion in various biological tissues is used in DW MRI. Objectives: The goal of this research was to evaluate the analytic exactness of DWI and the change in ADCs of the middle ear cleft cholesteatoma and non-cholesteatomatous tissue, particularly recurrent otitis media single-shot multi echo planar DW images. In the event of cholesteatoma , intraoperative findings and histological data would be used to validate the outcomes. In the event of otitis media, we will either follow up with the patients clinically to see whether their symptoms improve or if they need a CT scan. Patients and methods: At South Valley University Hospitals, this research was performed on patients with supposed cholesteatoma (supposed clinically or by CT scan) or branded those, as well as patients with suspected recurrence of otitis media who had previously had operation or were preparing for surgery. Results: Range of Mean ADC values of cases enrolled in this study which calculated by 3D synapse, even cholesteatoma or otitis media varies from 0.4 to 2.35 with mean average 1.028 Conclusion: DWI is a useful technique in the assessment of cholesteatoma because it distinguishes it from otitis media with high specificity, reducing needing next stare procedures in many instances.