Learning Objectives: How to perform a good canal wall up mastoidectomy.

Various techniques for cholesteatoma surgery have been developed, practiced, criticized, and favored by different otologists. The current dilemma regarding the choice of technique reflects differences of option between various schools of thinking in Otology. However, both the open and closed techniques have now been individualized, and the choice of procedure can be made in accordance with certain indications in order to optimize the results. In the 1960s Bill House popularized Canal Wall Up (CWU) mastoidectomies; since then CWU mastoidectomy has remained the ideal surgical treatment for pediatric cholesteatoma. This technique allows preservation of the hearing function without aestetic modification of the external ear. The limit of this technique is the incresed risk of cholesteatoma recurrence or residual; for this reason, a two-stages procedure is preferred. Indications for CWU mastoidectomy are cholesteatoma in pneumatized mastoids, children, limited epitympanic erosion, mesotympanic cholesteatoma, limited congenital cholesteatoma. Contraindications are a widespread disease, bony distruction and poor hearing. The aim of our presentation is to show technical refinements of this technique, focusing on surgical cases and results in pediatric population.