Background: Acquired middle ear cholesteatoma remains a common problem nowadays. The mainstay of treatment is surgery. Surgeries for cholesteatoma are usually classified as canal wall down (CWD) or canal wall up (CWU) procedures. The concept of canal wall reconstruction (CWR) mastoidectomy has been shown up in an attempt to combine the advantages of both CWD and CWU techniques. In this procedure, the posterior meatal wall (PMW) is removed, providing exposure to the entire attic and middle ear, helping to ensure complete disease eradication. Hence, the recurrence rate is as low as 2% for this procedure. Objective: This study aimed to assess the results of the reconstruction of the posterior meatal wall with bone and cartilage graft. Patients and Methods: This study was carried out on 24 ears of 24 patients in the Department of Otorhinolaryngology, Head and Neck Surgery, Zagazig University Hospitals during the period from September 2019 to September 2021. Twenty-four subjects were divided into two groups, group A (treated by canal wall down mastoidectomy with the reconstruction of the posterior meatal wall with cartilage from conchal cartilage), and group B (treated by canal wall down mastoidectomy with the reconstruction of the posterior meatal wall with bone from cortical bone). Results: There was a statistically insignificant difference between the cartilage graft group and bone graft group regarding post-operative complications. There was a decreased median of PTA-AC at post-operative cartilage graft compared to pre-operative; the difference was statistically significant with a percent of improvement of 31.36%. Conclusions: We concluded that CWDM eradicates disease in the middle ear and epitympanum by direct visualization and prevents common complications of the traditional CWDM technique.