For any otologist surgeon’s practice, ear surgery is the major part of it. With advancement and innovation in medical field, paradigm shift in surgical field seems to not new like open surgery to endoscopic surgery, endoscopic surgery to robotic surgery. The journey of endoscopy in ENT began over two centuries ago. In 1806, Philipp Bozzini from Germany introduced the Lichtleiter (“light conductor”), a simple tube with candlelight and mirrors to look inside body cavities.[1] In 1853, Antonin Desormeaux in France improved this idea with a brighter kerosene lamp and gave the instrument its enduring name—endoscope.[2] By 1932, Rudolph Schindler created a semi-flexible scope that could be navigated more easily, a principle later adapted for examining the ear, nose, and throat.[3] The real breakthrough came in 1957 when Basil Hirschowitz, working in the United States, used Harold Hopkins’ fibreoptic technology to produce a flexible scope with bright, clear images and minimal heat, making delicate structures like the ear canal and middle ear easier to examine without trauma.[4] Like that we can see the shift of attitude of specifically Otologist for ear surgery, from the microscope to endoscope. Initially, the endoscope in Otologic surgery was primarily used as an adjunct to microscope and limited only to diagnostic purposes. Recently otologist prefer to use endoscope for ear surgery as advantage of endoscope over microscope like seeing hidden area in middle ear, minimal invasive surgery (endo-meatal scarless surgery), better learning method of tools for the post graduate students, greater illumination with wide angle view. [5] Endoscopic Ear Surgery advanced rapidly during the past decade in most of the part of India. Unlike traditional microscopic surgery—which uses a binocular scope with a straight-line view—EES employs rigid endoscopes that deliver a wide-angle, panoramic view. This allows access to hidden recesses like the sinus tympani, epitympanum, and hypotympanum.[6] Globally, EES is gaining popularity, and India is following this trend—albeit with challenges related to its healthcare system. Over the past decade, interest in India has surged. Many ENT surgeons, especially in academic and urban tertiary centres, are now using endoscopes either alongside microscopes or independently. EES is now a regular feature in Indian otology workshops and ENT conferences, including hands-on segments.[7] ENT surgeons increasingly use endoscopes in ear surgery to improve their diagnosis and treatment of middle ear conditions. Instead of making larger incisions behind the ear, they can now insert a thin, rigid endoscope directly through the ear canal. This allows for a much clearer, wide-angle view of the middle ear structures, including areas that are usually hard to see with a traditional microscope Endoscopic ear surgery is considered minimally invasive. It causes less trauma to surrounding tissue, often results in quicker recovery, and avoids visible scarring.[8] However, the much advantage and innovation, in India we still seem to lag in Endoscopic ear surgery; particularly it is almost related the peripheral otology surgeons. Avoidance of endoscopic surgery for the special case or what are their attitude towards the endoscopic ear surgery? what are their issue related to using of endoscope in ear surgery? we have done survey to study about it in Gujarat, a state of India.

A questionnaire was developed and uploaded to a Google Form, consisting of 15 key questions focused on assessing surgeons’ experiences, the application of endoscopes in ear surgery, perceived benefits and drawbacks of endoscopic ear surgery (EES), and their preference between endoscopic and microscopic techniques based on personal experience. After obtaining informed consent from participants, the survey was distributed via email Otologists of Gujarat. The final data-set comprised responses from 100 professionals, including both experienced and early-career Otologists.

The study included 100 practitioners who shared their experience and opinions on the use of endoscopes in he field of Otology. In total 100 ENT surgeons, 46% were working at medical college institute, 44% were working at private clinic and 10% were working at both. 52% of the respondents were practicing at mega city and 48% were practicing at periphery. were first exposed to endoscopic ear surgery in past through their colleagues’ doctors, while 40% were exposed through conference related to EES. A total of 64% of the participants had never received any proper hands on training in endoscopic ear surgery. In the present study 32% of the surgeons were using the microscope most of the time while only 12% were using endoscope most of the time 30% ENT surgeons always prefer microscope for ear surgery. 28% surgeons believe to use both equally while 28% surgeons believe to use either of them depends on the case. 76% use microscope in extensive ear diseases while 22 % use both endoscope and microscope in extensive ear diseases. 56% otologist surgeons like endoscope but not using it because of single handed technique while 42% otologist surgeons not using it as they are habitual to microscope. 62% otologist surgeons believe single handed technique is the primary disadvantage of endoscope against microscope, while other disadvantage is limited depth perception, training requirement, difficulty in certain type of tissue removal, fish eye view in descending order 48% surgeons consider dissociation of motor and visual axis in camera assisted endoscopy surgery as a potential risk in using endoscope. 70 % surgeons consider incomplete visualization of hidden areas as a limitation of microscope.

In Otorhinolaryngology, the role of endoscopic ear surgery (EES) has expanded markedly over the past decade. Used as diagnostic tool previously now taking the role of main surgical tool in the practice of ear surgery. Large monitor displays now allow all surgical team members to share the same detailed view, enhancing both operative precision and teaching. These advancements enable minimally invasive, trans-canal access to complex recesses such as the sinus tympani, anterior epitympanum, and facial recess, often without the need for extensive bone removal.[9] The launch of online platforms by Indian ENT surgeons has also contributed to growing awareness. Surgeons with fewer years of experience (<10 years) tend to adopt EES more readily than their senior counterparts [10]. it is same as our survey as new bee surgeons (62%) better exposed with endoscopic ear surgery, tend to use endoscope more than well-established surgeons. There is a strong demand for formalized training through cadaveric dissection workshops, live surgeries, and fellowships. Modern EES benefits from high-definition optics with 0°, 30°, and 45° angled lenses, bright fibre-optic or LED illumination, panoramic visualization, and purpose-designed micro-instruments that improve the ergonomics of single-handed surgery. In the present study, 14% of ENT surgeons reported using endoscopes for Otological surgery, and 76% indicated they would adopt the technique with appropriate training. Similarly, Sharma et al. [11] reported that 90% of participants recognized a role for endoscopes in Otology. The main drawback identified in our study was the single-handed technique (62%), consistent with Sharma et al. [11] (83.6%). Other reported disadvantages included limited depth perception, the need for specialized training, difficulty in certain tissue removal, and “fish-eye” optical distortion. Half of the surgeons (70%) consider endoscope is better than microscope in ability to visualise hidden areas in our study which is similar to Badr-el-Dine et al. [12]. Respondents strongly supported structured training, suggesting computer-based simulation, endoscopic temporal bone dissection, and live surgical workshops, willing for training (76%). Although 70% of respondents viewed endoscopes as adjunctive rather than a complete replacement for the microscope as they (76%) prefer microscope for extensive ear diseases, their adoption is steadily increasing, particularly in lateral skull base and minimally invasive Otology surgery. With ongoing technological improvements and structured training pathways, EES is positioned to become an integral part of modern Otology practice.

Recent research underscores a significant rise in the adoption of endoscopes in Otology practices Gujarat. While many professionals are still in the process of mastering these techniques, there is widespread enthusiasm for incorporating endoscopes into ear surgery. Experts have proposed various methods to refine their skills, reflecting an increasing interest in this approach. This trend indicates a bright future for Otological endoscopic procedures as more specialists embrace advanced visualization tools. This survey highlights a growing interest and positive attitude among otologists surgeons toward the use of endoscopes. While many still rely primarily on the microscope, because they have not enough training or become used to it in their routine practice. The majority recognize the advantages of endoscopic techniques, particularly in terms of visualization and minimally invasive access. However, they have concerns about the learning curve and one-handed technique. Although Endoscopic Ear Surgery (EES) is widely used in top academic institutions and urban hospitals, its application in secondary and rural areas is limited, mainly due to gaps in training, financial constraints, and a lack of awareness. However, many still view endoscopic ear surgery as a complementary tool rather than a complete replacement for the microscope. Surgeons' attitudes are generally positive, but cautious, citing the learning curve and one-handed technique as key considerations. With increasing training and familiarity, especially among younger specialists, endoscopic Otology is likely to become more widely adopted in routine practice.

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