Based on data in literature the paper evaluates the extent of risk for the development of residual and relapsing cholesteatoma after a primary therapy of middle ear cholesteatoma by the occluded technique. This kind of technique has not decreased the risk over the last 40 years. In contrast, the higher frequency of middle ear cholesteatoma with prevailing defect of mesotympanum, with developed pneumatization and dysfunctional Eustachian tube, rather increased. The technique does not exclude the need of subsequent otology care and even does not secure significantly better results than other type of surgical treatment. It does not pose a greater risk from the point of view of complications, though. The risk of second or further cholesteatoma is generally on the average over 40%, the rate of re-operations is even greater. The risk, although lower, is also present in the open operations, which are accompanied by a higher frequency of inflammations of trepanation cavity especially in the child age.

        Key words: middle ear cholesteatoma, therapy, occluded technique, surgical treatment.