Soft tissue mastoid obliteration was used as a means to control a persistent draining mastoid cavity that would not respond to aggressive office management using meticulous cleansing, local antibiotics, and packing. Thirty-three draining cavities which could not be controlled medically, had soft tissue mastoid obliteration performed using a Palva flap. Of the 33 cases obliterated, 31 were successful in obtaining a dry cavity but two still required cleansing every four to six months. Primary reconstruction of the hearing mechanism was performed in 21 of the 33 cases, the others having severe pre-operative cochlear damage. Of those cases reconstructed, 13 were reconstructed using a TORP and eight were reconstructed using a hemi-incus interposition.