Bilateral External Auditory Canal Cholesteatomas

External auditory canal cholesteatomas are rare and estimated to be present in 1 of every 1,000 patients presenting to otologists.1 They may be classi- fied as idiopathic or secondarily acquired, most commonly occurring in postoperative or post-traumatic settings.2 Surgical treatment is usually curative, and the choice of operation depends on the extent of the disease. With extension into the mastoid, a mastoidectomy is required to remove all of the disease.3 The choice of canal-wall-up versus canal-wall-down mastoidectomy depends on the exposure required to be able to adequately assess and remove the full extent of the disease.3 Reconstruction of the posterior wall has been accomplished using a variety of materials, including cartilage2 and temporalis fascia.3 Given our patients extensive pneumatization, relatively discrete focal posterior wall defect, and intact tympanic membrane, we chose to reconstruct the posterior wall with tragal cartilage.