Chronic otitis media with cholesteatoma is considered an "unsafe" ear and generally requires surgical management. This is particularly challenging in children due to anatomical, pathophysiological and social reasons. There are different approaches for this objective. The two main options are the canal wall up and canal wall down mastoidectomy. The aim of this article is to compare the advantages and disadvantages of canal wall up and canal wall down method and present the third way of surgical management: the inside-outside approach through an endaural incision. This technique includes atticotomy, atticoantrostomy or mastoidectomy (mostly very limited) according to the size and location of the cholesteatoma. This technique contributes to the successful surgical management of cholesteatoma, eradicating the disease with the creation of small, dry, self-cleaning cavities and no pinna protrusion. Moreover, there is no need for meatoplasty or obliteration. However, we should never forget that in ear surgery the choice of the operative procedure should take into account the needs of the patient, the extent of the disease, and the surgeon's experience.