Minimal -invasive approaches is an evolution in Ci surgery . Due to its low tech approach it can be an be a valuable alternative to robot -assisted procededures in places where such sophisticated technology is not available. We report our 10 years experience and results in 150 patients with the Bremen approach. It shows that in the hands of an experienced otosurgeon this technique yields favourable results in terms of reducing trauma, operation time and surgical as well as aufdiologigal outcome.