The format of this lecture is based on discussion of clinical cases on surgical management of cholesteatoma. Each year we present new cases for discussion. Pre-operative endoscopic photographs, radiologic imaging, pre-operative audiometric tests, and clips from surgical videos will be presented. The presenters will engage in an interactive discussion on pre-operative surgical planning, decision-making process, and operative techniques for cholesteatoma surgery. The presenters will discuss the indications for exclusive endoscopic approach versus combined microscopic approaches. Although this course is targeted to surgeons with interest and experience in endoscopic ear surgery, we will discuss treatment options and operative dilemmas that are useful to all surgeons operating on cholesteatoma, regardless of their endoscopic proficiency or preference.