Aims and Objectives: This observational study is intended to identify the effectiveness of individual approach for each patient instead of a universal law of either Tympanoplasty alone or Cortical mastoidectomy with Tympanoplasty as a treatment for COM – mucosal type. Materials and Methods: This study comprises 100 consecutive patients who underwent surgery for the treatment of COM Mucosal type. We graded the Middle ear mucosa into six grades. All patients were followed up for a minimum of six months post operatively. Results: The graft uptake in our study was found to be 96% at the end of 6 months. Conclusion: A concomitant Mastoidectomy adds cost, surgical time and hospital stay to the patient among other things. However, Mastoidectomy should be done when there is evidence to suggest involvement of the mastoid compartment by the disease. The middle ear mucosa gives an indication of the disease status.