ObjectiveTo discuss the surgical method for Holt III external auditory canal cholesteatoma (EACC) invading the middle ear.MethodsClinical data of 35 cases with Holt III EACC undergoing surgical treatment in our department were analyzed retrospectively. Of them, 15 were male and 20 were female. Their age ranged from 15 to 66 years old with an average of 45. Microscopic resection of EACC was performed via external auditory canal approach in all the 35 patients.ResultsPostoperative followup for more than 6 months showed neither recurrence nor stenosis of external meatus. All the patients restored their hearing to normal with an average threshold of (23.3±1.3) dB by pure tone audiometry.ConclusionSimple resection of cholesteatoma via external auditory canal approach is feasible for the treatment of Holt III EACC, but close postoperative followup is essential.