Learning Objectives: Initial concerns regarding increased operative times when developing a novel EES practice are unfounded and should not deter otologists from becoming proficient at this technique.

Introduction: Endoscopic Ear Surgery(EES) has recently developed from being an adjunct to traditional microsurgery to becoming the principle methodology in select cases. Surgical use of the endoscope provides a wider field of view, increased depth of field and the ability to directly visualise ‘hidden’ areas of the middle ear.

Prolonged operative time is often considered a drawback when developing a novel application for minimally invasive surgery. There is limited data on the specific operative time of endoscopic tympanomastoid surgery compared to a conventional open approach.

Methods: Single-surgeon (senior author), retrospective case review of procedure time (retrieved from theatre computer logs) for patients undergoing tympanoplasty, or primary tympanomastoid surgery for cholesteatoma, during a period of transition from conventional open to a principally endoscopic ear surgery practice.

Results: 109 patients (7–85yrs) underwent tympanoplasty/primary cholesteatoma surgery. Entirely endoscopic technique in 22/42 tympanoplasty and 29/67 cholesteatoma procedures. Mean operative time for endoscopic tympanoplasty was 77.7 mins.(range 41–126 mins.), for open procedures 95.3 mins.(range 50–120 mins.). Endoscopic approach was quicker compared to open surgery (p = 0.031). In mastoid surgery the mean surgical time was 154 mins.(range 91–205 mins.) for the endoscopic technique and 169 mins. (64–259 mins.) for open surgery. There was no significant difference between these two groups (p = 0.082).

Conclusion: Operative time is not a drawback when transitioning from a conventional open to predominately EES otology practice. For tympanoplasty procedures it is significantly faster utilising the endoscopic approach. Endoscopic mastoid surgery has similar time to conventional techniques.