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Background and Objectives The aim of this study is to investigate the effectiveness of the endoscopic exclusive transcanalar approach for the management of conductive hearing loss. Subjects and Method This was a retrospective comparative study of 106 patients who underwent exploratory tympanotomy at Chonnam National University Hospital from January 2008 to March 2016. The subjects were classified into two groups; endoscopic tympanotomy (ET, n=26) and microscopic tympanotomy (MT, n=80). Demographic data, operation time, postoperative admission days, pure tone audiometric results of pre-operation and post-operation at 3 months, and hearing success rate were evaluated. Results The mean operation time of MT (101.7±24.8 minutes) was longer than that of ET (59.8±23.2 minutes) with a statistical significance (p<0.01). The mean postoperative admission days of MT (4.4±1.3) was longer than that of ET (2.0±0.6) with a statistical significance (p<0.01). Hearing gain (air-conduction) and air-bone gap improvements were not significantly different between the groups. However, the hearing success rate of ET [partial ossicular replacement prosthesis (PORP) 85.7%, total ossicular replacement prosthesis (TORP) 81.8%] was significantly improved enormously compared to that of MT (PORP 62.9%, TORP 64.3%). Conclusion With regards to conductive hearing loss, the endoscopic approach provided a better surgical view and less invasiveness compared with the microscopic approach. In conclusion, endoscopic exploratory tympanotomy had several advantages in operation time, admission days and hearing success rate. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(1):7-12

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