The introduction of intact canal wall tympanoplasty (ICWT) in 1958 by Jansen1received a mixed response from otologists. Many saw in it a means of improving treatment for cholesteatomatous middle ear disease because of both avoidance of postoperative cavity problems and the possibility of better functional results. Others—often those having experience with life-threatening complications following partial mastoidectomy—while conceding the possibility of short-term advantages, predicted an unacceptable incidence of eventual failure.While these reservations appeared to be strengthened by several papers delivered at the First International Conference on Cholesteatoma in 1976, there were also reports of encouraging results with low complication rates. Since then the otologic literature has been silent with regard to the controversy between those favoring and those condemning canal wall preservation in the cholesteatomatous ear. To clarify the situation, the results of a long-term study of my cases are presented here.