Endoscopic versus microscopic ear surgery in surgical education: a systematic review

Objective To systematically review the educational value of endoscopic ear surgery (EES) compared to microscopic ear surgery (MES) in otolaryngology training programs. Data sources PubMed, Web of Science, Cochrane Library, and Scopus (up to October 2025). Review methods A systematic review was conducted following PRISMA guidelines. Studies comparing EES and MES in educational settings (cadaveric, live surgery, or simulation) involving medical students, residents, or fellows were included. Outcomes were categorized into cognitive (anatomical knowledge), psychomotor (technical skills), and affective (perceived educational value) domains. Risk of bias was assessed using RoB 2, ROBINS-I, and JBI tools, and the certainty of evidence was evaluated using the GRADE approach. Results Eight studies ( n = 287 participants) met the inclusion criteria. In the affective domain, EES was consistently rated higher for perceived educational value, optical quality, and anatomical visualization, particularly by junior trainees. In the cognitive domain, objective assessments of anatomical knowledge acquisition showed no significant difference between modalities, though EES provided a shared perspective beneficial for early orientation. In the psychomotor domain, MES was frequently preferred by senior trainees for developing bimanual dexterity and depth perception. The overall certainty of evidence was low to moderate due to study heterogeneity and reliance on subjective measures. Conclusion EES and MES offer complementary educational benefits. EES excels in early-phase anatomical orientation and shared visualization, while MES remains crucial for advanced technical skill refinement. Otolaryngology curricula should integrate both modalities sequentially to optimize surgical competency.