After evaluation of the first 71 patients in this study, preoperative air-bone gap Ͼ20 (16.9% vs. 83.1, pϭ0.004) and pure tone average Ͼ20dB (21.1% vs. 78.9%, pϭ0.003 were the only preoperative factors associated with cholesteatoma recurrence. Intraoperatively, stapes erosion (OR 1.6, 95% CI 1.18-5.45) and cholesteatoma in the hypotympanum (OR 1.3, 95% 1.03-10.14) were the only factors associated with cholesteatoma recurrence. There were other factors approaching statistical significance and we expect them to when the larger sample size is evaluated. CONCLUSION: We have identified several factors that should make physicians increasingly vigilant for cholesteatoma recurrence and therefore more likely to perform a second look operation. While our data collection is still in process, we expect to identify further risk factors that are associated with cholesteatoma recurrence. Based on our large sample size, the data from this study will then be used to create an evidence based guideline for when to perform second look operations for cholesteatoma.