           !" # $ %!" & ’()*(!"  +(," (- ((" .  /! 0 ,1 -"     " - +--"  (%&(% )- Cholesteatoma is an aggressive disease and its management poses a greater challenge in children than in adults. This study reviews the experience of Universiti Kebangsaan Malaysia Medical Centre in the clinical presentation and management outcome of acquired cholesteatoma in paediatrics that required surgical interventions.   : A retrospective review of case records of patients below 18 years old who underwent surgery from 1999 to 2010. &-: A total of 46 pa( tients presented with 53 cases of cholesteatoma in which seven patients had bilateral disease. The age of presentation ranged from four to 18 years old with a mean age of 12 years. Male and female pa( tients were 65% and 35% respectively. Otorrhoea or previous history of otorrhoea on presentation was found in 94% and 96% of them had hearing impairment. Cerebellopontine angle abscess, sigmoid si( nus thrombosis and mastoiditis were among the complications. Tympanic membrane was retracted in 64% while 47% having had attic retraction and 53% had total atelectasis. A majority (85%) underwent canal wall down surgery with or without tympanoplasty. Post(operatively, 71% had improvement or preserved hearing level. The duration of follow up ranged from one month to 13 years and a quarter had recurrent disease and underwent revision surgeries. -: Majority of the cholesteatoma patients suffered from hearing loss and otorrhoea. Tympanic membrane retraction remained the most common clinical finding. Hence, children with persistent otorrhoea after adequate treatment may rep( resent cholesteatoma. Surgical options of canal wall up and canal wall down procedures have equal risk of recurrence. 2 "  2 -"  2 2"  " -    -: Bee See GOH Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia. Tel: +603 91456045, Fax: +603 91456675 E mail: irenegbs@yahoo.com         ),%&.%), Cholesteatoma is a condition where keratin debris produced by keratinised squamous epi( thelial cells accumulate in the middle ear cav( ity or any pneumatised part of the temporal bone. 1 The incidence in children ranges from