OBJECTIVE This study was designed to compare clinical features, surgical findings and treatment results from children and adults affected by aural acquired cholesteatoma. METHODS a retrospective review of 60 children (Group I: mean age 8.8 years, range 3-16 years) and 308 adults (Group II: mean age 45.4 years, range 18-81 years) with aural acquired cholesteatoma who underwent surgery from January 1992 to December 2002, was performed with a follow-up of 5 years. All patients were submitted to single-staged canal wall down tympanoplasty. Variables analysed were otoscopic features, extent of cholesteatoma, surgical findings and the rate of recidivism. RESULTS The pathologic changes in the tympanic membrane were no different in the two groups. According to Stangerup et al. 40 cases (66.6%) of children were classified as stage III or more, with a significant higher incidence compared to adults (152 cases; 49.3%). Analysis of the ossicular chain state showed, in group I, a significant higher incidence of eroded or absent incus (76.6% versus 61.68%) and malleus (76.6% versus 56.48%), if compared to adults. Children, therefore, had a significantly higher risk of recurrence with a rate of 26.6% in Group I and 6.81% in group II. After surgery the mean gain measured in children group, was 11 dB and 13 dB in adults. CONCLUSIONS In our study we found that the behaviour of cholesteatoma in children appears more aggressive than in adults. In fact, we found a greater extension of the cholesteatoma, a worse state of the ossicular chain and a higher incidence of recurrence. Therefore, we obtained acceptable hearing results both in children and in adults.