Learning Objectives: Cholesteatoma surgery is always in the edge for different decisions but when the disease takes place in children the situation is critical in many instances; preservation of hearing, surgical approach, surgical technique and diagnostic tools.

We will be presenting you, based upon our experience, the actual situation that cholesteatoma in children faces regarding diagnosis, surgical approach and results.

68 consecutive cases of cholesteatoma in children have been studied 71% underwent a closed technique and 29% an open thecnique. The most frequent clincal symptom was otorrhea and hearing loss (54%) followed by otorrhea (28%). 50% of the cases had an attical perforation and 26% a posterior marginal perforation. 83% of the cases had an sclerotic or diploic mastoid. The contralateral ear was normal in 70% of the cases. In the cases of cholesteatoma the mucosa was hiperplasic or polipoid in 92%. Cholesteatoma extended to attic in 79%, antrum 58%, posterior recces 38% and to mastoid 23%. The ossicles where damaged in 92% of the cases, being the incus the most frequently involved (70%). Residual or recurrent cholesteatoma appeared in 37% of the cases of closed surgery and 12% of the cases of open surgery. Recurrence of the cholesteatoma took place between 1 and 2 years postsurgery in 75% of the cases.

A critical review of the literature is made regarding diagnostic tools, recurrences in relation with open or closed techniques, functional results and a discussion about wether to perform single or second look surgery in closed techniques.