Patients with retraction pockets and small cholesteatomas need good surveillance as well as those surgically treated for cholesteatomas. This is particularly important in closed techniques where a second look or diffusion weighted MRI can pick up any recurrence or residual disease. Non-compliance with follow-up appointments is a common problem that apart from wasting resources, can jeopardise the patient. A case-controlled study is presented in which the authors compared 50 patients who were satisfactorily discharged with another 50 out of 410 (12.2%) who were lost to follow-up. It was noted that younger patients were more often the defaulters. The authors attribute factors such as movement, necessitated for employment or simply a greater tendency of the young to move. The other significant factor was residence in areas of education and training deprivation. Some other factors have been mentioned though not explored in the study, namely administrative factors, severity of disease or the lack of it and productive relationship with healthcare providers. Loss to follow-up is a significant problem, having personally seen one patient ending up with a brain abscess two years after the last appointment!