Introduction 11 2 7 10 1 8 Materials and methods Twenty-four patients (13 women and 11 men ranging in age from 12 to 51 years) were operated between 1998 and 2004. Various stages of cholesteatoma were detected during preoperative otoscopy and intraoperative observations in all those patients who had otorrhea and hearing loss for years. Four patients had complications such as facial paralysis, labyrinthine fistula and intracranial abscess. Ossicle chain injury of various severities was present in all these participants. All patients were operated under general anaesthesia. Prior to operation, each patient had otoscopic examination, pure tone and speech audiometry and temporal bone CT scans. Approval for radical mastoidectomy indication was granted after simple mastoidectomy and atticotomy. Operative technique 1 Fig. 1 CMOF MT BL EAC MC C  The following rules were attended during radical mastoidectomy. (1) All bony buttresses were excised and lowered as much as possible. This is called saucerization or skeletonization. (2) The mastoid apex was excised. (3) All related anatomic structures and loci were visualized. (4) All diseased tissues were removed. (5) White cortical bony tissues were reached in all directions. Moreover, large defects at the dural plate and or the sigmoid sinus were reconstructed with modelled autologous bone chips obtained from the operative field. 2 3 Fig. 2 above below SF MC CMOF SS BL EAC S  Fig. 3 Pr BL E S FG SF SS  Postoperative antibiotics and anti-inflammatory medicines were continued for 1 week. Skin sutures were removed on the 7th postoperative day. The cavity dressings were removed on the 14th day. Antibiotic and steroid drops were used at the end of the second postoperative month. In all patients epithelization of the cavity completed at the end of the 2nd month. Temporal bone CT scanning was done to observe the neo-osteogenesis in the mastoidectomy cavity and the CMOF on the 1st, 12th and 24th months. The EAC volume was measured on the second, 6th, 12th and 24th months. The volume measurements were done with saline, warmed up to the body temperature that was filled into the EAC up to the level of the posterior line of the meatoplasty. The head position was horizontal during the measurement. Data of the study were analysed by the statistical package for social sciences (SPSS) for Windows 10.0. Results This study was done between the years 1998 and 2004 in 24 patients. All patients were followed-up for at least 2 years. EACs were smooth and healthy. In all patients epithelization was complete after the 2nd month of the operation. None had recurrent osteitis, cholesteatoma or granulation. Otoscopic examination could reveal the entire cavity in all these cases and debris and cerumen cleaning was feasible. 3 4 Fig. 4 a b  None of our patients returned with vertigo induced by cold air or swimming. No aesthetical disapproval occurred. Introducing the hearing aid placements into the EAC was easy and almost natural. The therapeutical results in four patients with preoperative complications were successful. In one patient conchal perichondritis emerged soon after the operation and was treated with medical therapy. Discussion 1 10 4 8 13 6 5 Fig. 5 The external ear meatus in the second postoperative year  5 12 3 6 Fig. 6 Calcification foci indicating osteblastic activity are seen in histologic investigations 6 months after surgery (HE ×400)  11 8 9 Conclusion Some large meatoplasties performed for open cavity problems are not preferable due to non-aesthetic appearance. On the other hand, small meatoplasties that are preferred to overcome this concern cause aeration and drainage problems by increasing the depth of mastoidectomy cavity posteriorly. Therefore, in this study we both performed small meatoplasties to avoid the aesthetic concerns and at the same time filled the mastoid cavity up to the posterior edge of the meatoplasty to obtain efficient aeration and drainage.