To summarize our experience with the 320 children who underwent cochlear implantation by the suprameatal approach (SMA). The SMA involves entering the middle ear by retroauricular tympanotomy. After drilling of the cochleostomy and of the suprameatal tunnel, the electrode is passed through the suprameatal tunnel underneath to the chorda tympani and lateral to the incus into the cochleostomy. The following implant-related complications required explantation with subsequent reimplantation: foreign body reaction (0.6%), allergy to implant (0.3%), and protrusion of the positioner (0.3%). Post-traumatically displaced magnets were reinserted in 3 (0.9%) children. All the vestibular (5.3%) and wound (3.1%) problems were considered as being patient-related and resolved spontaneously or were managed conservatively. There were no surgery-related complications and no cases of mastoiditis developed among the children implanted with the SMA. The SMA enables a decreasing the rate of surgery-related complications and safe electrode insertion.