This was a thought-provoking article examining the reasons why the authors believe that the endoscope is enabling an improved understanding of acquired cholesteatoma and its management. They describe in depth the ventilation pathways of the middle ear, and how they are formed between the ossicular ligaments and folds. These anatomical descriptions are accompanied with endoscopic images of temporal bone dissections. This is also supported by embryological descriptions of the middle ear space formation. There is a description of the three main ways in which endoscopes could be used to approach an acquired cholesteatoma, depending on the disease extent and the host anatomy (with respect to access). Disappointingly these descriptions were short, although succinct. I felt that for an otologist on the brink of adopting this technique, supporting information regarding the group’s experiences of the technique, including difficult areas and how they overcome them, but also some preliminary data regarding their recurrence/residual rates would have been immensely beneficial. Despite this, the arguments for using the technique were well set out.