Middle ear cholesteatoma in childhood is discussed on the basis of 117 operated cases. Early diagnosis was rare, even after fetid otorrhea of long duration; occassionally they presented as acute mastoiditis. The cholesteatoma occurred mostly in older children (90%) and extended to the antrum (73%) or beyond it (54%), with destruction of the ossicles (77%); the hearing often remained normal. Tympanic membrane perforations were usually small, relatively often they were central. More than 50% of the children had normal mastoid pneumatization, usually there were no typical radiological signs of cholesteatoma. Tympanoplasty was most frequently type III (68.5%), the postoperative hearing gain in this group was 47.3%. Residual or recurrent cholesteatoma occurred in 8.5%.