The debate regarding the surgical technique for the management of cholesteatoma still continues. The resolution of this issue will only come with the study of the long term results of well controlled series. In this paper long term follow-up on three groups of patients is reported. The groups underwent combined approach tympanoplasty (CAT), mastoid tympanoplasty with obliteration (MOT), and modified radical mastoidectomy (MRM) respectively for cholesteatoma. The factors studied included frequency of required review, condition of the external canal/cavity, and hearing status. The meatal cross-sectional areas and cavity volumes were also measured for the MRM and MOT groups. Analysis of the data showed no significant difference between the groups in either frequency of review or cavity status. The hearing results showed an initial improvement in all groups, however, over the prolonged follow-up period the air conduction threshold gradually increased. In conclusion this data supports the view that a one-stage canal wall down procedure provides maximum long term patient benefit.