The role of endoscopes in otologic surgery is growing as optical systems become increasingly sophisticated with smaller diameters and improved resolution. This author has performed 52 transtympanic middle ear endoscopic procedures in the office since 1990. Endoscopy, as a diagnostic procedure, was found to be a valuable technique yielding high quality examinations that eliminated the need for surgical exploration in all but one patient. Examinations were well tolerated, and no complications have occurred. It is anticipated that endoscopy will become an important technique for diagnostic middle ear exploration. Surgical intervention by endoscopy may prove useful in the future as dedicated otologic instruments become available, and laser systems are integrated.