Material and methods. The study included 125 patients with middle ear cholesteatoma, from 1 year to 17 years (131 cases — 6 patients had bilateral cholesteatoma). All patients were operated in the ENT department of St. Petersburg State Medical University from 2000 to 2017. A comparative analysis of the clinical course and results of surgical treatment of the middle ear cholesteatoma in two age groups was performed: 1 group (1—6 years) — 34 patients (37 cases); 2 group (7—17 years) — 91 patients (94 cases). Results and discussion. The average duration of the period from diagnosis to surgery was 7.1±6,4 months in the 1 group and 27.3±23.1 months in the 2 group. This is due to a brighter and more aggressive manifestation of cholesteatoma in children under 7 years old. Due to extensive bone destruction and cholesteatoma, 30% of children of the 1st group underwent radical surgery on the middle ear, in the 2nd group — only 15%. The postoperative period in children under 7 years was more unfavorably: large radical cavities, their late epithelization, growth of granulation tissue. The percentage of cholesteatoma recurrence after hearing-saving operations in the 1st group was 50%, in the 2nd group — 25%. Conclusion. The tendency to a more unfavorable course of the disease in young children has been identified. This must be taken into account in choosing the type of operation and predicting the course of the disease.