OBJECTIVE Despite a lot of scientific advancements in otology, canal wall-down mastoidectomy is still considered to be the standard of care in the management of extensive cholesteatoma. To avoid large cavity related problems, mastoid obliteration has been described in the literature for many decades. Controversy prevails among otologists regarding the materials used for obliteration. This study aimed to evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement. METHODS Retrospective analysis was performed of all consecutive patients who underwent canal wall down mastoidectomies and primary mastoid obliteration with ready-to-use, self-setting hydroxyapatite bone cement. Minimum follow-up was 1 year. Primary Outcome measures include need for explantation and post-operative complications. RESULTS Total of 26 patients were included in the study. Only one patient required complete explantation. All patients acquired dry cavities in the final follow-up. Few minor complications including external auditory canal granulations and post-aural wound dehiscence. There was no cholesteatoma recidivism. CONCLUSIONS Ready-to-use, self-setting hydroxyapatite bone cement serves the purpose of mastoid obliteration. In addition, it is time efficient and requires less expertise. It has excellent outcomes in terms of cholesteatoma recidivism. We recommend further research in this area with a large cohort.