Background: Cholesteatoma is a surgical disease for which the primary universally accepted goal is total eradication of cholesteatoma to obtain a safe and dry ear. The second objective is restoration or maintaining the hearing. Objective: This study was aimed to solve the problem of residual cholesteatoma and decrease the problem of large mastoid cavities and to increase the learning curve of endoscopic ear surgery. Patients and Methods: non-randomized controlled trial study performed in Otolaryngology, Head and Neck Surgery Departments, Zagazig University Hospitals in the period from February 2018 to February 2021 on 30 patients suffering from middle ear cholesteatoma. Otoendoscopic evaluation were used for detection of the presence of attic perforation, posterosuperior perforation, aural polyps and, whitish shadow behind intact tympanic membrane. All patients were operated under general anesthesia with controlled hypotensive technique. Results:  After 1 year of follow-up in 15 patients using endoscopic approach and 15 patients using microscopic approach, the recidivistic cholesteatoma was found in 6.7% in endoscopic group while it was 20% in microscopic group. Conclusions: It could be concluded that the use of an endoscope provided important benefits to patients with middle ear cholesteatoma and offer superior visualization than microscope.