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Background: The prognostic factors of facial paralysis complicated by middle ear cholesteatoma (MEC) are largely unknown due to limited reports and smaller sample size. Objectives: This study aimed to analyze prognostic factors of postoperative outcomes of facial paralysis complicated by MEC. Material and methods: Clinical data of 48 patients (48 ears) with facial paralysis complicated by MEC were retrospectively reviewed and analyzed. The outcomes of facial paralysis were compared between different groups. Results: All the eight cases (100%) with intact fallopian canal had complete recovery of facial paralysis after surgery, while only 52.5% cases (21/40 cases) with fallopian canal damage achieved good recovery, with significant difference (p < .05). For subgroup analysis of the 40 cases with damaged fallopian canal, the good recovery rate of facial paralysis in shorter duration group (2 months) was higher compared to longer duration group (>2 months) (81.0% versus 21.1%; p < .05). Moreover, the good recovery rate of facial paralysis in moderate facial paralysis group (grade II–IV) was higher compared to severe facial paralysis group (grade V–VI) (82.4% versus 30.4%; p < .05). Conclusions and significance: The outcomes of facial paralysis complicated by MEC were associated with fallopian canal integrity, duration and severity of facial paralysis. [ABSTRACT FROM AUTHOR]