Introduction: Chronic Suppurative Otitis Media (CSOM) is a common ear condition in India and many other parts of the world. The incidence of CSOM is estimated at more than 20 million people worldwide. It is characterized by chronic middle ear and mastoid cavity inflammation, typically leading to persistent ear discharge and hearing loss. mastoid cavity obliteration with postauricular soft tissue in canal wall down (CWD) mastoidectomy is likely to see several advancements and refinements aimed at improving patient outcomes, surgical efficiency, and overall healthcare effectiveness, especially with Minimally Invasive Approaches.Objectives: The objectives of the study were to evaluate the surgical outcomes of mastoid cavity obliterationusingpostauricular soft tissue in patients undergoing CWD mastoidectomy for CSOM with cholesteatoma.Methods: The study was a hospital-based prospective study with a sample size of 48 subjects, divided into case and control groups. The primary outcome measure was the creation of a dry, infection-free, low-maintenance mastoid cavity as assessed by a grading system developed by Merchant et al.The study used a cohort of patients undergoing CWDM for CSOM with cholesteatoma, with postauricular soft tissue used to obliterate the mastoid cavity. Patients were evaluated for ear discharge and epithelialization at 15, 45, and 90 days post-surgery using the Merchant et al grading system for otorrhea.Results: The study found that 50% of the case group subjects had no or minimal ear discharge on day 15, compared to 20% in the control group. At day 45, 79% of case group subjects attained grade 0 ear discharge, while only 50% of control group subjects did.At day 90 the study revealed that 87% of subjects had no discharge, while only 66% of control had no discharge.The study found that 33% of subjects in the case group had epithelialisation by day 15, while only 24% attained epithelisation by day 15 in the control group. By day 45, 63% of subjects in the case group had fully formed epithelial tissue, compared to 38% in the control group.At day 90, 88% of subjects have fully formed epithelial tissue over the surgical site in the case group 54% in the control group. The study found that the use of postauricular soft tissue in CWD mastoidectomy leads to better surgical outcomes, including reduced ear discharge, faster healing, and improved epithelial tissue formation. Conclusions: The study concludes that the use of postauricular soft tissue for mastoid cavity obliteration in CWD mastoidectomy leads to better outcomes, including faster healing, less discharge, and improved epithelialization.