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BACKGROUND: endoscopic ear surgery in patients Chronic Otitis Media(COM) media with eardrum atelectasis. OBJECTIVE: to compare the postoperative outcomes and audiological results of the endoscopic approach versus the microscopic approach for treatment of COM media with eardrum atelectasis, using a randomized prospective model. METHODS: Sixty patients were consecutively enrolled in the study and randomized into two groups: Group A 32 patients underwent canal wall up tympanoplasty (CWA); Group B 28 patients underwent tympanoplasty with an exclusive trans-meatal endoscopic approach. Audiological results and preoperative, intraoperative and postoperative outcomes were evaluated. RESULTS: No statistical difference emerged between distribution of middle ear atelectasis patients grade 3 and 4 between the two surgical groups (p > 0.05). The group B appeared to have shorter surgical times than group A (69.8 min vs. 88.9 min). The graft success rate was estimated in 90.6% and 92.8% in group A and B respectively, without statistical differences between groups (p = 1). The Overall success rate was therefore calculated in 87.5% and 92.8% for both groups. CONCLUSION AND SIGNIFICANCE: Endoscopic ear surgery could be a suitable approach for treating COM media with eardrum atelectasis with similar results compared with the Microscopic surgery.