Disease that lies in the posterior mesotympanum, including inflammatory polyps, cholesterol granuloma, and cholesteatoma, is often difficult to extirpate. The literature reflects a divided and often controversial opinion regarding the removal of the bony posterior canal wall to reach this disease. Recently, endoscopic visualization has been advocated to enhance exposure. Employing a fallopian bridge technique wherein the bone medial to the facial nerve is opened into the posterior mesotympanum the authors have used this approach in selective circumstances to optimize the eradication of disease. Three hundred patients undergoing tympanomastoidectomy were included in this analysis. The fallopian bridge technique was attempted in 58 cases and was successfully employed in 42 patients. Indications as well as limitations for this procedure are discussed.