We return this year with another session bringing you all new clinical cases. The format of this lecture is a practical one: based on a discussion of clinical case scenarios of patients with cholesteatoma. Pre-operative clinical pictures, 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 utilize predominantly endoscopic techniques and will discuss the indications for exclusive endoscopic approach versus combined microscopic approaches. The session will focus on illustrating techniques on how to manage extensive adult and pediatric cholesteatoma, challenging situations such as labyrinthine fistula, encephalocele, cholesteatoma in critical areas and identification of crucial anatomical landmarks in the context of advanced chronic ear disease to perform safe surgery and prevent complications. The presenters will illustrate operative techniques to reconstruct attic defects to prevent recurrent disease, autologous ossiculoplasty techniques and indications and methods for selective mastoid obliteration.