The management of cholesteatomatous ear disease by open cavity mastoidectomy is plagued by a number of cavity problems. A chronically discharging cavity besides being a frustrating dilemma to the surgeon is also a social handicap to the patient. Obliteration of such discharging cavities seems to be an effective therapeutic modality. This paper deals with mastoid obliteration using a vascularized axial pattern temporoparietal fascia flap. Twenty post-mastoidectomy cases were retrospectively studied for cavity problems and prospectively for efficacy of the technique in terms of achieving a dry ear and hearing improvement. Also included is an extensive review of literature regarding the various causes of cavity problems and techniques of obliteration.