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Purpose: To present the surgical technique and clinical outcomes of a novel modification to conventional meatoplasty., Materials and Methods: All consecutive patients undergoing canal wall down tympanomastoidectomy incorporating the one-cut meatoplasty technique between January 2009 and February 2013 were evaluated. Primary outcome measures included meatal stenosis requiring revision surgery, frequency of drainage beyond 2months postoperatively and results of a composite patient questionnaire incorporating the Chronic Ear Survey., Results: Twenty-eight of 36 (78%) eligible patients completed a questionnaire and were included. All ears underwent canal wall down tympanomastoidectomy utilizing the one-cut meatoplasty technique. At a mean follow-up of 38.0months, the average Chronic Ear Survey score was 78.6±2.6 points. There was only one case of postoperative meatal stenosis. Intermittent otorrhea developed in 14.3% of cases but was remedied by conservative measures including in-office cleaning, ototopical therapy and water precautions. Eighty-nine percent of patients denied any self-consciousness about the aesthetic appearance of the ear., Conclusions: The one-cut meatoplasty is an effective alternative to traditional techniques that is simple to perform. The results of the Chronic Ear Survey indicate that the one-cut meatoplasty supports a stable and healthy, open cavity with functional results that compare favorably to other series evaluating canal wall down tympanomastoidectomy with traditional meatoplasty. Additionally, patients report high satisfaction with the appearance of their ear, and all hearing aid users could continue to utilize a hearing aid without feedback, pain, or other difficulties related to poor fitting., (Copyright © 2015. Published by Elsevier Inc.)