Endoscopic Surgery for Chronic Middle Ear Disease: A Narrative Review of Surgical Techniques and Results

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.