Aural cholesteatoma is usually associated with an attic or a posterior superior marginal perforation and accompanied by a history of malodorous discharge, often with hearing impairment. But cholesteatoma may present itself as an unexplained hearing impairment without an attic perforation, retraction or otorrhea, and often with radiologic evidence of mastoid sclerosis. Clinical study was made on 3 cases of primary acquired cholesteatoma with intact tympanic membrane which was diagnosed by exploratory tympanotomy and treated with atticoantrostomy and tympanoplasty, with concise review of literature.