First of all, a consultation with the anesthetist. And after induction of anesthesia, tracheoscopy and inspection of the endolarynx up to the bifurcation. Inconspicuous conditions here. No indication of mucosal irregularities. After intubation, perform hypopharyngoscopy, microlaryngoscopy and pharyngoscopy. In each case, the findings were unremarkable except for the prescribed lesion approx. 1 cm in size in the area of the hard palate, which then had extensions of reddish altered mucosa to the soft palate. After another flexible gastroesophagoscopy has been performed, which reveals an inflamed mucosa in the stomach, the local erosion is then successively dissected out with the CO2 laser and the handpiece with 10 watts of power in the case of suspected neoplasia in the sense of an excision biopsy. This works well. Suture marking with a short-short suture marker for the front and a long-long suture marker for the side. The preparation is sent for final histology. Now, after careful hemostasis, repositioning for ear surgery on the right side. After sterile draping, an auxiliary incision and counter-incision are made. Overall very heavy bleeding in the patient, who is under heparinization and has low thrombocytes of 80,000. This bleeding made the operation considerably more difficult. Due to a history of coronary heart disease, it is unfortunately not possible to inject xylocaine or lidocaine with added adrenaline. After further careful hemostasis, a Stacke II flap is developed and the cholesteatoma originating in the anterior wall is exposed in the auditory canal. This is cut around in a circular fashion. The skin of the auditory canal is then dissected to form an anterior tympanomeatal flap and the cholesteatoma sac is completely released. This is also successful. At the same time, a bony stenosis of the ear canal is revealed, so that this is partially drilled away with the diamond drill very carefully and with great difficulty in order to protect the anterior tympanomeatal flap, which continues to bleed. This also works well. Better view towards the tympanic membrane. Tragus cartilage is now removed. Careful hemostasis here too. The tragus cartilage is then inserted as a cartilage perichondrium plate to reconstruct the anterior wall of the auditory canal. In addition, perichondrium is placed over it to equalize the level of the remaining ear canal skin. Filling of the ear canal with vibravenous gel. Suture of the auxiliary incision. Ointment strip tamponade and, after consultation with the anesthesiologist, completion of the procedure.