Endoscopic ear surgery uses a small rigid camera called an endoscope to give the surgeon a detailed view of the ear canal, eardrum and middle ear during an operation.
Modern ear surgery can be performed using an operating microscope, an endoscope, or a combination of both.
The endoscope is particularly useful because it provides a wide view from within the ear canal. Angled endoscopes can also help the surgeon inspect areas of the middle ear that may be difficult to see using a straight line of sight.
However, endoscopic ear surgery is not automatically the best approach for every patient. The technique used depends on the condition being treated, the anatomy of the ear and the objectives of the operation.
Endoscopic ear surgery explained
Often through the natural ear canal.
Wide-angle, magnified view of the middle ear.
May be endoscopic, microscopic or combined.
Treat the underlying ear condition safely.
What is endoscopic ear surgery?
Endoscopic ear surgery is a technique in which a surgeon uses a rigid endoscope to see inside the ear during an operation.
It is sometimes called transcanal endoscopic ear surgery, or TEES.
“Transcanal” means that the surgeon approaches the middle ear through the natural ear canal.
A small camera is connected to the endoscope. The image is displayed on a high-definition monitor, allowing the surgeon to see a magnified view while performing the operation.
The endoscope takes the surgeon’s view into the ear canal
Instead of viewing the ear only from outside through a microscope, the endoscope can be positioned within the ear canal. This provides a closer and wider perspective of selected middle-ear structures.
Why can the endoscopic view be useful?
The middle ear contains several very small structures packed into a confined space.
These include the three hearing bones — the malleus, incus and stapes — as well as nerves, membranes and small anatomical recesses.
Some of these areas can be difficult to inspect using only a direct line of sight.
An endoscope provides a wide field of view. Angled endoscopes can also help the surgeon look into selected recesses within the middle ear.
The middle ear contains areas that are effectively “around a corner”
An operating microscope remains extremely valuable, but its view follows a relatively straight optical path.
Endoscopes can provide additional viewing angles. For selected operations, this can help the surgeon inspect areas that are less directly visible with a microscope alone.
What procedures can involve endoscopic ear surgery?
Endoscopic techniques can be used during several types of middle-ear surgery.
Eardrum Repair
Endoscopic techniques may be used during selected operations to repair a persistent perforated eardrum.
Eardrum repair → 02 ReconstructionMyringoplasty
Myringoplasty involves reconstruction of a persistent perforation in the tympanic membrane.
Myringoplasty → 03 Middle earTympanoplasty
Tympanoplasty may involve repair of the eardrum together with other middle-ear structures where required.
Tympanoplasty → 04 Hearing bonesOssiculoplasty
Reconstruction of damaged middle-ear hearing bones may form part of selected ear operations.
Ossiculoplasty → 05 Chronic diseaseCholesteatoma
Endoscopes can be useful when inspecting selected areas during surgery for cholesteatoma and chronic ear disease.
Mastoid surgery → 06 Specialist treatmentEndoscopic Ear Surgery
Read more about the endoscopic approach and how suitability is assessed.
Explore treatment →What happens before endoscopic ear surgery?
The first step is establishing exactly what is happening inside the ear.
The surgeon will normally review your symptoms, previous ear infections, hearing difficulties, previous operations and other relevant medical information.
Understand the symptoms
Hearing loss, discharge, infection, discomfort, tinnitus and previous ear problems are considered.
Examine the ear
The ear canal and tympanic membrane are examined to understand the condition and anatomy.
Assess hearing
Audiological testing may be used to determine the type and degree of hearing loss.
Decide on the surgical approach
The surgeon can then decide whether an endoscopic, microscopic or combined technique is appropriate.
Surgery should be an individual decision
Your surgeon should explain why the procedure is being recommended, reasonable alternatives, important risks and what you can expect during recovery.
The fact that an endoscopic technique is available does not mean surgery is required or that an entirely endoscopic approach will be appropriate.
What actually happens during the operation?
The exact steps depend on the condition being treated.
In a transcanal endoscopic procedure, the surgeon introduces the endoscope carefully through the ear canal.
The endoscope provides illumination and a magnified image of the surgical area on a monitor.
Specialist instruments are then used alongside the endoscope to perform the operation.
Inspect the ear
The endoscope provides a detailed view of the eardrum, ear canal and selected middle-ear structures.
Reach the treatment area
Where necessary, part of the eardrum may be carefully elevated to provide access to the middle ear.
Perform the required procedure
The surgeon carries out the repair, reconstruction or disease removal required for the individual condition.
Reconstruct where required
The eardrum or middle-ear structures may then be reconstructed according to the operation being performed.
What happens during an endoscopic myringoplasty?
Myringoplasty is an operation designed to close a persistent perforation of the tympanic membrane.
During an endoscopic myringoplasty, the ear canal provides a natural route towards the eardrum.
The surgeon can inspect the perforation and surrounding structures using the endoscope before preparing the repair.
Graft material is then positioned to reconstruct the tympanic membrane.
The exact graft material and surgical technique depend on the perforation, anatomy and surgeon’s assessment.
Does endoscopic ear surgery mean there is no incision?
Not necessarily.
Some ear procedures can be performed predominantly through the natural ear canal.
In selected cases, this may avoid an incision behind the ear purely for surgical access.
However, endoscopic does not mean incision-free.
An additional incision may sometimes be needed, for example to obtain graft material or where the condition requires a wider surgical approach.
More extensive disease involving the mastoid may also require mastoid surgery.
Endoscopic versus microscopic ear surgery
Endoscopic and microscopic ear surgery are not simply competing techniques.
Each provides different advantages, and both can be useful during modern ear surgery.
Microscopic ear surgery
The operating microscope provides magnification, binocular vision and depth perception.
It also allows the surgeon to operate with both hands while maintaining the microscopic view.
Endoscopic ear surgery
The endoscope provides a wide field of view from within the ear canal.
Angled scopes can also improve visualisation of selected recesses in the middle ear.
What are the limitations of endoscopic ear surgery?
Endoscopic surgery also has technical limitations.
One-handed technique
The surgeon generally holds the endoscope in one hand while using instruments with the other.
Bleeding can affect the view
Blood on the endoscope can obscure the image and requires careful management.
Heat management
The endoscope’s light source generates heat, which the surgical team manages during the procedure.
Not suitable for every case
Some disease requires microscopic access, mastoid surgery or a combined approach.
Is endoscopic ear surgery better than microscopic surgery?
There is no single technique that is automatically better for every patient.
Endoscopic techniques can provide excellent visualisation of selected parts of the middle ear and may allow a transcanal approach in suitable cases.
Microscopic surgery remains an important part of otology and may be preferable or necessary for other conditions.
In some operations, the surgeon may use both techniques.
The priority is to choose the approach that allows the underlying condition to be treated appropriately and safely.
How is the endoscope used during cholesteatoma surgery?
Cholesteatoma is an abnormal collection of skin cells within the middle ear or mastoid.
It can involve recesses of the middle ear that can be difficult to inspect directly.
An endoscope can therefore be useful for examining selected areas during cholesteatoma surgery.
However, cholesteatoma may extend beyond the middle ear and into the mastoid.
More extensive disease may require mastoid surgery, microscopic surgery or a combined approach.
In cholesteatoma treatment, the priority is control of disease and creation of a safe ear.
Can endoscopic surgery involve the hearing bones?
Yes.
Sound is transmitted through three small middle-ear bones called the malleus, incus and stapes.
Chronic disease, cholesteatoma, trauma or previous surgery can sometimes damage this ossicular chain.
Where clinically appropriate, reconstruction of the hearing bones may be considered.
This operation is called ossiculoplasty.
Hearing improvement cannot be guaranteed because the eventual result depends on several parts of the ear and the underlying condition.
What happens after endoscopic ear surgery?
Recovery depends on the procedure performed.
Ear surgery is not one single operation, so patients should follow the postoperative instructions provided for their particular procedure.
Packing may be present
Packing or dressings may be placed within the ear canal depending on the operation.
Hearing may initially feel reduced
Packing, swelling and the healing process can make the ear feel blocked during early recovery.
Keep the ear protected
Water precautions are commonly advised after eardrum and middle-ear surgery.
Attend postoperative review
Follow-up allows the surgeon to assess healing and the condition of the ear.
When will my hearing improve?
Hearing should not be judged immediately after an ear operation.
Packing, swelling and healing can temporarily affect hearing.
The eventual hearing result depends on the original condition, the eardrum, the middle-ear hearing bones, the inner ear and the procedure performed.
Some operations are primarily intended to repair an eardrum or control disease rather than guarantee improved hearing.
When can I fly after endoscopic ear surgery?
There is no single postoperative flying interval that is appropriate for every ear operation .
The advice depends on what surgery was performed and how the ear is healing.
Your surgeon should tell you when it is appropriate to fly after your individual operation.
This is different from an untreated perforated eardrum. NHS guidance generally advises that flying with an untreated perforation is safe.
What are the risks of endoscopic ear surgery?
The risks depend mainly on the operation being performed and the condition being treated rather than simply on whether an endoscope is used.
Other risks may apply depending on the procedure.
Your surgeon should discuss the risks that are relevant to your individual operation before you decide whether to proceed.
Not every ear condition should be treated entirely endoscopically
Some patients are suitable for predominantly transcanal endoscopic surgery.
Others require microscopic surgery, mastoid surgery or a combined approach.
Suitability is based on the examination findings, hearing, previous surgery, disease extent and individual ear anatomy.
Who may be suitable for endoscopic ear surgery?
Suitability cannot be determined from symptoms alone.
An ENT surgeon specialising in ear disease will consider the underlying diagnosis and anatomy before recommending a surgical approach.
Factors may include the position of an eardrum perforation, the condition of the middle ear, hearing results, previous operations and the extent of any chronic disease.
Imaging may also be relevant in selected cases.
The role of surgical experience
Endoscopic ear surgery requires specific equipment, training and familiarity with operating through a different visual perspective.
Mr Max Whittaker is a Consultant ENT Surgeon with specialist interests in otology, chronic ear disease, hearing loss and minimally invasive endoscopic ear surgery in adults and children.
His advanced training includes Otology and Skull Base Surgery at Guy’s and St Thomas’, together with international observership experience focused on endoscopic ear surgery.
About Mr Max Whittaker →Questions to ask before endoscopic ear surgery
If an ear operation has been recommended, you may find it helpful to discuss the following questions with your surgeon.
Why is surgery being recommended?
What is the main objective of the operation?
Why is an endoscopic approach being considered?
Could microscopic surgery also be required?
What alternatives are available?
What are the important risks in my case?
What should I expect during recovery?
What follow-up will I need?
Endoscopic ear surgery FAQs
Is endoscopic ear surgery keyhole surgery?
It is often described as minimally invasive because the natural ear canal can provide a surgical route in selected cases. However, the exact procedure varies and additional surgical access may sometimes be required.
Am I awake during endoscopic ear surgery?
Anaesthetic arrangements depend on the procedure, individual patient and treatment setting. Your surgical team will explain the planned anaesthetic before the operation.
Will endoscopic surgery improve my hearing?
Hearing outcome depends on the underlying condition and the structures involved. Improvement cannot be guaranteed. In some operations the main objective may instead be eardrum repair or control of chronic disease.
Can endoscopic ear surgery repair a perforated eardrum?
Endoscopic techniques may be used during selected myringoplasty or tympanoplasty procedures. Whether the approach is appropriate depends on the individual perforation and ear anatomy.
Is endoscopic ear surgery suitable for cholesteatoma?
Endoscopes can be useful during selected cholesteatoma operations, particularly for inspecting middle-ear recesses. More extensive disease may require mastoid or microscopic surgery.
Is endoscopic surgery always less painful?
No blanket claim should be made about pain. Postoperative discomfort depends on the operation, the surgical access required and the individual patient’s recovery.
What endoscopic ear surgery involves
Endoscopic ear surgery uses a small rigid camera to provide a magnified, wide-angle view of the ear canal and middle ear.
It may be used during procedures including myringoplasty, tympanoplasty, ossiculoplasty and selected cholesteatoma surgery.
Some operations can be performed predominantly through the natural ear canal. Others require microscopic surgery, mastoid access or a combination of techniques.
The most appropriate surgical approach depends on the condition being treated and the individual anatomy of the ear.
Related patient information
This page is for general information only and does not replace individual medical assessment, diagnosis or treatment. Seek prompt medical advice for sudden hearing loss or other urgent symptoms.
