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To determine the rate of residual cholesteatoma during planned second-look procedures in pediatric patients following primary cholesteatoma resection using endoscopic and microscopic operative approaches.Case series with chart review.Tertiary care center.Outcomes from pediatric patients undergoing cholesteatoma surgery from January 2011 through August 2015 were analyzed. Cholesteatoma extent at initial resection was staged, and comparison among endoscopic dissection and microscopic or endoscopic inspection groups was made. Presence of disease at time of planned second look was quantified. Descriptive analysis was performed.Fifty-five patients (56 ears) with planned second-look procedures were included and underwent a total of 120 procedures. Median age was 11 years (6.7-13 years). Endoscopes were used for inspection in 25 (39%) primary resections and for dissection in 39 (61%) primary resections. Extent of disease at the time of primary resection was similar among groups (χ2, P = .72). Cases where the endoscope was used for inspection only or not at all during primary resection had a 24% rate of residual cholesteatoma at the time of second look compared with a 23% rate for cases with endoscopic dissection (χ2, P = .93). Rate of mastoidectomy significantly decreased from 63% to 33% over the study period (P = .04) with similar disease extent (P = .99).Residual cholesteatoma rates during planned second-look procedures were similar between the study groups. Use of the endoscope led to a lower rate of mastoidectomy for cases with similar disease extent.