Aim: To access the usage of the endoscopy in round window (RW) orientation during cochlear implant (CI). Methodology: This was a retrospective case series study done in Otolaryngology Department, Tanta University, Egypt in 2018 and 2019. Inclusion criterion was all cases with CI surgery in which the endoscopy was used to locate the round window (RW) when this was difficult through the transmastoid approach. Results: The total cohort consisted of 13 CI patients in which endoscopy was used. Age mean was 35.5 years. Situations necessitating the usage of endoscope were: 6/13 with cochlear rotation, 4/13 with very narrow mastoid cavity, and 3/13 with narrow facial recess. By using the endoscope, the RW was fully visualized in all patients and CI insertion done through it. Conclusion: The endoscopy was of great value in some difficult CI cases.