This Panel Presentation will address problems commonly seen in cholesteatoma treatment, using actual cases to discuss situations encountered at surgery. It is intended for general otolaryngologists, residents, and fellows, and audience participation will be encouraged. Three academic otologists with >100 years of combined experience will present options in management, and their treatment preferences and outcomes. Basic principles will be reviewed, including wall up versus wall down mastoidectomy, middle ear reconstruction, and meatoplasty. Cases will be presented that illustrate issues in management, including the use of endoscopes, facial nerve monitoring, second stage surgery, recidivism, and management of complications.