The success of mastoid surgery is partly determined by the ability of the surgeon to achieve a dry functioning ear with socially adequate hearing. Open cavity mastoid surgery, though commonly employed by many surgeons, does not lend itself easily to achieving these objectives. We aim to discuss and outline the management of resistant cases of chronic otitis media with cholesteatoma/mucosal disease with persistent recurrent discharge. Inadequate drainage (high facial ridge) with inadequate meatoplasty besides residual and recurrent disease is cited as the common causes for non-healing/persistent discharge in a mastoid cavity; however, persistent mucosal disease with inadequate epithelialisation is often overlooked as a cause for the discharging cavity. We describe various techniques in mastoid obliteration as a method for eliminating this variable and achieving a small, dry, self-cleansing cavity that is amenable to primary or secondary hearing reconstruction. This is an instructional course utilising line drawings, original pictures and videos in a power point presentation highlighting the various techniques which can be utilised for mastoid obliteration in ears with chronic otitis media with persistently discharging mastoid cavities secondary to cholesteatoma / mucosal disease. Additionally, a simple to use algorithm for mastoid obliteration will be presented.