Background Recently, endonasal surgeries and treatments become easier and familiar due to increased usage of endoscopy. However, the comparison between Endoscopic and Microscopic examination of the middle ear is underinvestigated. Aim Our work is aimed to, compare endoscopic and microscopic dissection of the middle ear through posterior tympanotomy, evaluating essential areas, anatomic marks, and the main technical difficulties. Patients and methods Thirty human wet cadaveric temporal bones were selected for the study from an autopsy material of Anatomy and Embryology department Benha University. Only twenty specimens without traumatic damage were selected for the study, which was approved by the University Research Ethics Committee. Standard operating room microscope at x 2.2 magnification, Storz Endoscope with optics of 30 degrees, a diameter of 2.7 mm Endoscopic camera, and various size diamond drills. Results The gained data describing the visualization of Foot plate of stapes proved that the poor and excellent visualization expressed significant difference with P˂0.05. While, the visualization of Eustachian tube evidenced that all data representing the poor, good and excellent visualization of the Hypotympanum showed a significant difference with P˂0.05. Both the good and excellent visualization displayed a significant difference with P˂0.05 using Microscope and Endoscope. There was a significant difference with P˂0.05 between the poor and excellent visualization of Sinus tympani. There was a significant difference with P˂0.05 between the poor visibilities of Round Window. Conclusion The Endoscope conferred excellent visualization of middle providing better images of hidden structures with wide-angle view and diverse directions of the lens.