Learning Objectives: Surgery for cholesteatoma is especially challenging in a pediatric population because of the need for hearing preservation. Hence canal wall up mastoidectomy in a single or two stages should be the approach of choice in the pediatric population. Here we describe the steps of canal wall up mastoidecomy in a difficult case of far anterior epitympanic cholesteatoma in a pediatric patient. The result was a complete removal of the disease and preservation of the ossicular chain. The patient is disease free 10 years on follow-up.