We recently reviewed the records of 1024 operations for aural cholesteatoma, of which 181 were in children. Our surgical management was the same as for adults. Complications of the disease (labyrinthine fistula, facial paralysis, total sensorineural impairment, and meningeal complications) were less common in patients under 16 years of age. This appears to be related to duration of disease rather than to age. The disease in children tends to be more difficult to eradicate. Staging the operation is required more frequently and there is a higher incidence of residual disease at planned second-stage operations. Postoperative serous otitis media, though infrequent, was more common in those patients 16 years of age and older than in children. Persistence of this middle ear fluid, requiring a ventilation tube, was more common in younger children. The functional results of reconstructive middle ear surgery were the same in adults and children.