Objective: Management of pediatric cholesteatomas remains controversial. We reviewed our 16-year experience in the surgical treatment of cholesteatomas in children and describe a treatment paradigm. Study Design: The authors conducted a retrospective review. Methods: A total of 106 mastoidectomies (86 for an acquired cholesteatoma and 20 for a congenital cholesteatoma) were performed in children 16 years old and younger from 1988 to 2003. Follow up ranged from 2 years to 12 years with a mean

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... low-up period of 6 years. Hearing outcomes, cholesteatoma recidivism, and dry mastoid cavity were the main outcomes measured. Results: Seven (7%) patients had revision surgery for cholesteatoma recidivism. Rates of cholesteatoma recurrence for canal all up (CWU) and canal wall down (CWD) mastoidectomy groups were similar (8% vs. 6%). The percentage of patient with good serviceable hearing (pure-tone average <25 dB) was higher in those with a CWU mastoidectomy as compared with the CWD mastoidectomy group (81% vs. 47%) (P < .05). Extent of disease and stapes superstructure erosion on presentation were significant (P < .05) predictors of both cholesteatoma recidivism and poor hearing. All 106 subjects studied had a dry mastoid and 78 patients (74%) had a maintenancefree cavity at the time the study was completed. Conclusion: The treatment of pediatric cholesteatomas should be individualized with CWD mastoidectomy chosen for patients with recurrent or more extensive disease. We conclude that the CWU procedure is an adequate surgical option for treating most acquired and congenital cholesteatomas, preventing disease recurrence, and maintaining good hearing outcomes. Key Words: Pediatric cholesteatomas, canal wall up mastoidectomy, canal wall down mastoidectomy.