Learning Objectives: This narrated eight minutes video lecture demonstrates the surgical anatomy and the surgical steps involved in eradication of a holotympanic cholesteatoma through an exclusive transcanal endoscopic approach with preservation of the middle ear space and mastoid antrum and avoidance of a radical mastoidectomy.

Objective: This narrated surgical video illustrates the transcanal endoscopic approach to a holotympanic cholesteatoma with extension in the sinus tympani and Eustachian tube. This video demonstrates the advantages of the endoscopic approach to visualize and gain access to disease in anatomical subsites that traditionally would have required a posterior tympanotomy and a radical mastoidectomy.

Methods: A pre-operative endoscopic exam and a CT scan of the temporal bone were obtained for surgical planning and assessing extension of the cholesteatoma. The surgery was performed under general anesthesia. Rigid 0 and 30 degree endoscopes, 3 mm in diameter and 14 cm in length were used and connected to a three chip video camera and high definition monitor. The surgical procedure was performed working from the images on the monitor.

Results: The holotympanic cholesteatoma was removed utilizing a transcanal endoscopic approach by direct visualization and removal of the disease from the retrotympanum, epitympanum, periantral mastoid cells and protympanum. Reconstruction of the tympanic membrane and attic defect was performed with a composite tragal cartilage graft. The mastoid antrum was not involved and was preserved intact.

Conclusions: Endoscopic ear surgery is a valuable surgical technique and offers wide field visualization of the retrotympanic space, attic, periantral mastoid space and protympanum. In this video a transcanal endoscopic approach is utilized to access and remove cholesteatoma involving the sinus tympani and the Eustachian tube with mastoid preservation and avoidance of a radical mastoid cavity.