Introduction:
Due to the changing trends in the presentations of chronic ear disease , as well as the advances in its diagnosis and treatment, FMMS presents a logical surgical solution for tympano-mastoid cholesteatoma in the 21st century It stresses the fact that the middle ear should be the primary target of otosurgeons to clear pathology and reconstruct the hearing mechanism. Mastoidectomy is performed, only if necessary, to approach the middle ear posteriorly and to clear pathology extensions if needed.