Papilla opening is one of the very common steps in middle ear mastoid surgery, where large cavities are often left after removal of the lesion. These mastoid cavities take a long time to epithelialize during the post-surgical recovery process and need to be matched with a large ear canal opening at the same time. Without a sufficiently large ear canal opening, the epithelialization process on the one hand can be affected, leading to a long-term inability to dry the ear and even infection. This leads to the possibility of a second surgery for the patient. On the other hand, a small ear canal opening can also interfere with the postoperative cleaning of the large mastoid cavity. Therefore, an open mastoid cavity with concomitant auricular cavity molding surgery was the conventional surgical management by otologists in the past. However, with our increased cosmetic requirements and the need for some patients to wear hearing aids post-operatively. The management of the mastoid cavity has also changed considerably. In order to shorten the postoperative recovery time, avoid larger mastoid cavities and ear canal openings, and meet the needs of patients who need to wear hearing aids after mastoid surgery. We use a more varied approach to mastoid filling. Bone powder can be used to fill the surgical cavity (including the superior tympanic chamber and mastoid process) while completely removing the lesion. A posterior tipped musculocutaneous flap, an upper tipped temporalis muscle flap, and an inferior tipped sternocleidomastoid muscle flap can be applied simultaneously or separately. The mastoid cavity can be adequately reduced or completely filled to obtain a relatively normal ear canal and ear canal opening for cosmetic and hearing aid wear, in addition to avoiding the problem of vertigo from mastoid cavity irritation in extreme environments.