This study has been conducted in order to analyze the outcomes of a previously described technique for chronic otitis media surgery: the improved radical mastoidectomy with flap (formerly IRMF), which consisted of improved radical mastoidectomy (formerly IRM), inferiorly based fascioperiosteal flap and large meatoconchoplasty (Kahramanyol, Ear Nose Throat J 71:70-77, 1992; Kahramanyol et al., Ear Nose Throat J 79:524-526, 2000). The technique is hereafter referred as the Gulhane mastoidectomy. During a period of 22 consecutive years, 255 patients have been operated on and treated utilizing the technique mentioned above. Despite extensive otologic destruction and concomitant severe complications, the technique rendered impressive outcomes: the cavities became smaller over time and remained healthy, providing good life quality for the patients. Cholesteatoma recurrence was observed in but one patient. The outcomes confirm the value and usefulness of the technique.