According to our strategy, a transcanal approach through retroauricular incision can be used only in limited cases of cholesteatoma. To prevent recurrence of the cholesteatoma, we believe that it is important to maintain bony wall as much as possible when canal wall down technique is not used. Therefore, we do not pursue distal end of cholesteatoma by removing the posteri- or wall widely from the bony meatus. The use of this approach in our group is therefore limited only to the cases with small pars tensa cholesteatomas with minimal invagination into the attic and the facial recess, or congenital cholesteatomas mainly localized in the tympanic cavity. Since a wide external auditory canal is a prerequisite of the safe surgery, technique to carry out appropriate meatoplasty safely is of tremendous importance. The bone removed in the surgery to enlarge the approach to the cholesteatoma should be securely closed using a sufficiently large piece of cartilage. If there is a necessity to enlarge the approach, or the matrix is disrupted in invisible area from the small atticotomy, we convert the technique to canal wall up to ensure eradication of the disease under the preserved canal wall. Refer to the case presented in this chapter (see ▶Fig. 5.1, ▶Fig. 5.2, ▶Fig. 5.3, ▶Fig. 5.4, ▶Fig. 5.6, ▶Fig. 5.7, ▶Fig. 5.8, ▶Fig. 5.9, ▶Fig. 5.10, ▶Fig. 5.11, ▶Fig. 5.12, ▶Fig. 5.13, ▶Fig. 5.14, ▶Fig. 5.15, ▶Fig. 5.16, ▶Fig. 5.17). Additional cases are also shown in Chapter 8.