Abstract: Objective A retrospective cohort study was conducted at a single centre with the objective of analysing the clinical characteristics and surgical outcomes of paediatric cholesteatoma of the middle ear. The objective of this study was twofold: firstly, to validate the effectiveness of the European academy of otology and neurotology/Japanese otological society(EAONO/JOS)staging in guiding individualised surgical approaches, and secondly, to identify independent risk factors for postoperative recurrence. Methods A total of 171 paediatric patients(177 ears)with middle ear cholesteatoma under 14 years of age, admitted from January 1,2005 to December 31,2024, were included in the study. A retrospective analysis was conducted to extract core clinical features such as patients' clinical manifestations, imaging characteristics, surgical methods, and postoperative follow-up results. Chi-square tests were used for the purpose of classification, with indicators including characteristics of different types of cholesteatoma and surgical efficacy at different stages. Multivariate logistic regression analysis was employed to explore the significant factors influencing postoperative recurrence of paediatric middle ear cholesteatoma. Results The prevalence of cholesteatoma was found to be higher in males, with a peak incidence observed between the ages of 8 and 10 years. No significant difference was observed between the left and right ears. The predominant clinical manifestations were otorrhea(83.0%)and hearing loss(71.9%), with foul-smelling ear canal secretions(36.3%)serving as a significant distinguishing feature. Complications included subperiosteal abscess behind the ear. Perforation of the pars flaccida(51.4%)and diploetic mastoid(76.2%)were frequently observed. Cholesteatoma has a propensity to invade the epitympanum and antrum, followed by the posterior tympanum and mastoid process. The most prevalent ossicular chain injury pertains to concurrent involvement of the incus and incudostapedial joint. In 29.4% of cases, the tympanic segment of the facial nerve was exposed. According to the EAONO/JOS staging system, the majority(89.3%)of cases were classified as stage Ⅱ disease. Postoperative follow-up was conducted in 150 cases, with a range of 0.5-14 years, and recurrence was observed in 3 cases(2.0%). The pure-tone average and air-bone gap demonstrated significant postoperative improvement(all P<0.001). Multivariate analysis indicates that type Ⅳ ossicular chain injury is a significant predictor of postoperative recurrence. Conclusion Pediatric middle ear cholesteatoma is characterised by distinct clinical and pathological features. A surgical approach based on EAONO/JOS staging(atticotomy/antrotomy for stage Ⅰ, open radical mastoidectomy for stages Ⅱ-Ⅳ)has been shown to yield favourable outcomes. It is imperative that patients undergo regular postoperative follow-ups in order to monitor the contralateral ear, manage packing material retention, address membranous atresia, and facilitate early detection of recurrent cholesteatoma.

Key words: Children, Cholesteatoma, Tympanitis, Ear surgery, EAONO/JOS staging