Cholesteatoma of the middle ear is a life-threatening condition that requires surgery. Cholesteatoma of the middle ear in children and adolescents is considered more aggressive, and achieving both eradication and restoration of hearing is one of the most difficult challenges in modern otology, and it is generally believed that complete wall curettage with auditory bone reconstruction is more advantageous than debridement for preserving hearing in children. Approximately 13% of children with cholesteatoma have bilateral disease. If bilateral debridement is used, it will be extremely difficult for the child’s hearing and will last a lifetime. In our department, more than 100 cases of cholesteatoma surgery using various techniques, including the wall-complete method, have resulted in 85% hearing restoration to within 20 dB. Due to the unique nature of growth and development of adolescent children, treatment of middle ear cholesteatoma needs to be highly individualized, taking into account anatomical, clinical and social factors to determine the most appropriate surgical approach. Cholesteatoma has the risk of causing life-threatening intracranial complications, and in the past, eradication was the first priority and hearing protection was the second. However, with the development of ear microsurgery techniques, social progress, and the patient’s increased demand for quality of life, hearing protection is increasingly becoming the primary need of small patients who are technically able to do so. The practice of doing only radical treatment without considering hearing protection and reconstruction in order to prevent complications is increasingly unacceptable and unpopular with patients. In fact, complications from cholesteatoma, especially intracranial complications, only develop intracranially when the bony wall between the middle and outer ear is very intact and hard and the adjacent cranial wall is relatively weak; intracranial complications can be avoided as soon as the middle ear surgery opens up the middle ear wall even a little bit and the weak point is between the middle and outer ear, when the pressure toward the cranium is shifted to the outer ear. Therefore, it is entirely appropriate and possible to balance the risk of cholesteatoma removal with hearing reconstruction. Of course, it is also important to see the special characteristics of cholesteatoma in children and adolescents. We have found that cholesteatoma in children and adolescents is characterized by delicate bone, rapid accumulation of skin capsule, rapid and extensive destruction, and easy residual and recurrence. During surgery, we saw severe destruction of the auditory bone and only the pedicle remained in the stapes, which necessitated the use of a gun column (i.e., equivalent to type IIIb). However, despite recurrence, after another or 3 surgeries, all of them can be obtained to avoid recurrence and the hearing mostly returns to normal level. Most of the cholesteatomas operated on for the first time by the completion method not only result in a safe, dry ear and a normal ear canal, but hearing improvement or even a return to normal is also entirely possible.