Learning Objectives: ï Multidiscplinary pre-operative planning. ï Modern day Otologist should be proficient in both microscopic and otoendoscopic technique.

Introduction: The aim of cholesteatoma surgery is to eradicate the disease process with minimal morbidity and preservation of hearing. The use of the oto-endoscope as a surgical tool is becoming increasingly popular for safe cholesteatoma surgery. We believe that the combined use of the oto-endoscope and microscope helps in achieving the above goals and reduce the need for second look procedures or revision surgery.

Methods: We did a retrospective review of 43 cases of mastoidectomy performed between January 2011 and January 2016 in our otology unit in East London.

Results: We reviewed cases of combined approach tympano-mastoidectomy, atticotomy, revision mastoid surgery and cholesteatoma eradication from antrum in anteriorly lying sigmoid sinus .Our study group involved both adults and paediatric population. After the full microscopic work all cases were assessed using oto-endoscope for any residual diseased epithelium particularly on the on the lateral wall of epitympanum, anterior attic and sinus tympani. Residual disease was dealt with micro-instruments and/or KTP LASER. In 21 cases, residual diseased epithelial remnant was still present.

Conclusion: A combined oto-endoscopic and microscopic approach in the management of cholesteatoma cases helps to achieve a good outcome without any additional morbidity. This has reduced the need for revision surgery and second look procedures.