Objective To provide an overview of Endoscopic Ear Surgery, its development, principles, and penetration in otology practice in 2018. Data Source PubMed review of literature and cross‐sectional email survey of otologists. Methods We reviewed all PubMed published articles on use of endoscopy in practice of otology over the last 50 years. Articles were categorized based on date of publication and pattern of utilizing the endoscope. We also conducted two identical email surveys in 2010 and 2018 of otologists on the use of endoscope and tabulated and compared results. Results The number of publications on use of endoscope has increased from 6 in 1990 to an accumulated total of 451 in 2018. There has been a clear shift in the area of interest away from diagnostic endoscopy, to endoscope‐assisted surgery, and lately, to transcanal endoscopic ear surgery (TEES). Survey results further documented the increased awareness of the value of the endoscope and its increased use in clinical practice. Conclusion TEES has gained traction as a subject of research interest and in clinical practice and has lately dominated the discussion on the use of endoscope in otology. Level of Evidence NA