An understanding of the differences between adult and paediatric cholesteatomas should be helpful in more effective management of the disease in children. In this study, the authors focused their comparison between paediatric and adult cholesteatomas to the operative findings, rates of revision surgery required and postoperative complications. This retrospective study comprised 71 operations performed on 58 children and 281 operations carried out on 260 adults. Cholesteatomas in children were more extensive, infiltrating into sinus tympani and mastoid air cells. They showed a higher incidence of ossicular erosion. However, the requirement for revision surgery for cholesteatoma did not show any significant difference between adults and children and neither did the complication rates and postoperative audiometric results. The study confirms the more aggressive nature of cholesteatomas in children which is attributed to reports in literature, suggesting elevated levels of monoclonal antibody MIBI, and some other features at cellular level. Earlier detection of cholesteatoma in children and timely management is emphasised in this study.