The endoscopic approach to the middle ear in the eradication of cholesteatoma is now usually performed in association with the microscope utilisation. During the second look procedure, otoendoscopy allows to develop a new concept of surgery under video-control including minimal approach with a height quality of eradication control. In our series, we report 54 consecutive cases operated on intact canal wall-up technique, by the same surgeon. The mean follow-up delay was 29 months. Systematic second look was performed within the two first years following surgery. 76% of the patients underwent minimal endoscopic approach. CT scan and/or MRI were performed in 37 patients before second look in order to correlate radiological and surgical findings. Second look results shows 45 patients on 54 (83.3%) with normal ear (no cholesteatoma recurrence), and 9 patients (16.66%) with residual cholesteatoma. Free air cavities were demonstrated by CT scan in 40.5%, localised opacities in 7.9% and total opacities in 51.4%. All free air cavities on CT scan and MRI were non residual cholesteatoma ears. MRI cannot be used to screen for small cholesteatoma or to determine the characteristics of an opacity of the middle ear seen on CT in order. Therefore second look surgery is the gold standard study to diagnosis a residual cholesteatoma. Minimal endoscopic second look approach is a new cholesteatoma surgery concept better accepted by patients.