ObjectiveTo determine the importance of supratubal recess in cholesteatoma surgery by presenting the clinical presentation, imaging findings, and surgical treatment methods of 66 patients with cholesteatoma. We propose that the management of supratubal recess allows the opportunity for total removal of the cholesteatoma with the prevention of recurrence.Study DesignRetrospective review of surgical cases.SettingTertiary referral center.InterventionsDiagnostic and therapeutic procedures were performed.Patients and MethodsWe present a series of patients with involvement of supratubal recess by reviewing the operative charts of 347 patients surgically treated for aural cholesteatoma between 1990 and 1999.ResultsWe detected the involvement of supratubal recess in 19% (n = 66) of our operations for aural cholesteatoma removal.ConclusionThe intent of this study is to improve the chance for a successful outcome by decreasing the rate of recurrence. The surgical approach to supratubal recess in cholesteatoma operations is emphasized with our series.