Learning Objectives: To describe in children: 1. prevalence of cholesteatoma growth patterns; 2. hearing impairment; 3. contralateral ear alterations.

Introduction: Acquired middle ear cholesteatoma in children is a rare event. Over the years, many studies have elaborated the differences between cholesteatoma in children and adults. The clinical findings and the cholesteatoma growth patterns are known to be distinctive in children.

Methods: In a cross-sectional study, videotoscopy data of 155 pediatric patients were analyzed for cholesteatoma growth patterns. They were subjected to an audiological evaluation. We also analyzed the contralateral ear (CLE), classifying it as normal, TM perforation, outside-in TM perforation (in instances with signs of previous TM retraction), moderate and severe TM retraction, and cholesteatoma.

Results: Cholesteatoma growth patterns were posterior epitympanic in 23.2% patients, posterior mesotympanic in 40.6% and both in 17.4% of the patients. Anterior epitympanic growth pattern was observed in 4.5%. In 14.2% the growth pattern was undetermined. The observed pure tone average for bone conduction was 8.8 dB (SD 13.4), for air conduction was 39.7 dB (SD 21.79) and for air-bone gap was 32 dB (SD 15.61). There was no difference between the cholesteatoma growth patterns and the pure tone average for bone conduction (p = 0.6), for air conduction (p = 0.42) and for air-bone gap (p = 0.32).

A normal CLE was observed in 34.8% of the patients. Moderate or severe TM retractions were observed in 45.2%, TM perforation in 7.1%, and cholesteatoma in 12.9%. Of all the TM perforations, outside- in pattern was observed in 63.6%.

Conclusion: Posterior mesotympanic cholesteatoma was the most prevalent in the study population. Most patients had a conductive hearing loss irrespective of the cholesteatoma growth pattern. The most prevalent CLE abnormalities were moderate or severe TM retraction and cholesteatoma.