Conclusions: As cholesteatoma is widespread and erosive, it should be cleared away thoroughly, to keep a dry ear and conserve maximum hearing ability in children. Canal wall-down mastoidectomy with mastoid and epitympanum obliteration is a good choice for treatment of cholesteatoma in children. Objective: To investigate canal wall-down mastoidectomy with mastoid and epitympanum obliteration for the treatment of cholesteatoma in children. Patients and methods: A retrospective analysis of all cases of pediatric middle ear cholesteatoma in children aged 5-12 years between 1999 and 2006 was conducted in Anhui Provincial Hospital. The follow-up information was completed. Forty-five patients (48 ears) were treated with canal wall-down mastoidectomy with mastoid and epitympanum obliteration and followed up for 2-5 years (mean 3.1 years). Results: The recurrence rate and residual rate were 4.16% and 0%, respectively. All ears were dry within 8-10 weeks. Aural discharge was detected in two cases and controlled with antibiotic car drops without complications. The dry car rate was 95.8%. The air bone gap closure had a mean of 17.2 +/- 2 dB. No obvious complication occurred after operations.