This is a retrospective review looking at two groups of patients who had undergone middle ear surgery for chronic otitis media (perforation, retraction pocket/cholesteatoma) either open or endoscopic. Four hundred and five patients underwent open ear surgery and 501 endoscopic, of these, 155 and 144 patients in each group, respectively, underwent cholesteatoma surgery. Two approaches were used, retroauricular and transcanal and the incidence recorded of residual cholesteatoma at second look surgery at 12-months post-initial surgery. The results showed a residual cholesteatoma rate at second look surgery of 16.1% (25/155) in the open group compared to 5.6% (8/72) in the endoscopic group, which was statistically significant. This is a useful study, showing that endoscopic techniques can achieve good outcomes with low morbidity and a small residual rate of cholesteatoma in experienced hands.