Since cholesteatoma is a slow growing expansile mass which can cause intratemporal and intracranial complications by destructing surrounding bone it should be surgically eradicated.Complete excision of cholesteatoma is the primary aim of interventions However to preserve or restore the hearing and balance function can not be ignored. Currently newborn hearing screening allows early detection of conductive hearing loss in newborns. After eliminating possibility of fluid in the middle ear cleft any congenital cholesteatoma confined to anterior attic can be diagnosed by CT scans ( or diffusion MRI ).In such a case transcanal approach may be adequate to excise the cholesteatoma.In a similar way congenital cholesteatoma behind intact tympanic membrane can be detected in childhood by combination of ototmicroscopy and CT or MRI scans in very young children.However any supratubal congenital cholesteatoma may not be diagnosed till to late ages and sensorineural hearing loss or recurrent facial paralysis can be a sign which leads to diagnosis. Currently some limited attic or sinus cholesteatomas can also be managed transcanally by the aid of an endoscope if the surgeon is familiar to endoscopic techniques.However if the cholesteatoma goes beyond the lateral semisircular canal a closed or open tympanomastoidectomy approach is required.Method can be chosen according to extent of disease. In this presentation current surgical approach to cholesteatoma would be given with short video clips and rules,hints and limitations of each technique would be discussed.