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Review Article
Endoscopic ear surgery is a safe, effective, and versatile approach to address multiple middle ear diseases, offering comparable audiological outcomes to traditional microscopic techniques while reducing morbidity and improving visualization of difficult middle ear regions.
Endoscopic ear surgery (EES) is transforming contemporary otologic practice by enabling minimally invasive transcanal access and enhanced visualization of middle ear anatomy. This narrative review summarizes current technical considerations, clinical applications, and recent evidence regarding EES in tympanoplasty, ossiculoplasty, and cholesteatoma surgery. Technical factors influencing safety and efficacy include the use of angled endoscopes, the management of thermal risk from light sources, hemostasis, underwater endoscopic techniques, and emerging digital image enhancement systems. For type I tympanoplasty, endoscopic and microscopic approaches achieve comparable graft uptake and hearing outcomes, while EES may reduce operative time, postoperative pain, wound-related complications, and approach-related morbidity, particularly compared with postauricular microscopic surgery. Endoscopic ossiculoplasty also demonstrates audiological outcomes comparable to microscopic reconstruction, with potential benefits in operative efficiency and postoperative recovery in both adult and pediatric populations. In cholesteatoma surgery, EES provides wide-angle visualization and access to hidden recesses, and meta-analyses suggest lower residual or recurrent disease rates compared with traditional microscopic approaches. However, disease extension, particularly mastoid involvement, remains a key determinant of surgical strategy. Overall, EES is a safe, effective, and versatile technique for chronic middle ear disease, offering excellent clinical and audiological outcomes with minimal surgical morbidity.
Over the last two decades, endoscopic ear surgery (EES) has reshaped otologic practice by improving visualization of the middle ear. Technical advancements enabled a totally endoscopic transcanal approach to middle ear diseases. Although EES was initially adopted by only a few pioneering groups, it has progressively gained popularity and is now widely used in otologic reference centers worldwide. Beyond its established middle ear applications, the feasibility of EES for accessing selected lateral skull base corridors, including infracochlear, suprageniculate, and transpromontorial approaches, has been investigated1. Potential new indications an....
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Part I. General technical and safety considerations
Overall safety
Although safety concerns were raised during the early adoption of the technique, subsequent clinical experience has demonstrated the safety and reliability of exclusive EES. In a large retrospective series of 825 exclusive EES procedures, Marchioni et al. found no major intraoperative complications, including dural, vascular, or persistent facial nerve injury. Minor intraoperative complications occurred in 4.1% of cases, while early postoperative complications were reported in only 1.3%. Delayed complications affected less than 1% of patients, supporting th....
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Endoscopic ear surgery has become an integral component of modern otologic practice, offering a safe, effective, and minimally invasive approach for the management of chronic middle ear disease. Current evidence supports its use in type I tympanoplasty and ossiculoplasty, where anatomical and audiological outcomes are comparable to those achieved with microscopic techniques, while perioperative morbidity, postoperative pain, wound complications, and operative time may be reduced. In cholesteatoma surgery, EES provides su.......
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The authors have no conflicts of interest or competing financial interests to declare.
The manuscript was supported by OpenAI’s ChatGPT-5.5 model for assistance with grammatical editing and language refinement.
The AI tool was employed only for editing support; all ideas and conclusions are the work of the authors.
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