Objectives: Within the last few years, oto-endoscopes have been in use for inserting transtympanic ventilation tubes. However, in terms of published studies, only a limited number have investigated the efficacy of endoscopic myringotomy and tube placement in children. The aim of this prospective study was to evaluate the feasibility of endoscopic ventilation tube insertion in children by comparing the duration and outcomes of endoscopic versus microscopic technique. Method: The study included 39 children in total (22 boys and 17 girls) aged 2-10 years and diagnosed with chronic otitis media with effusion (COME). In Group A, ventilation tube insertion was performed using oto-endoscopy in 15 patients (29 ears). In Group B, ventilation tube insertion was performed using surgical microscopy in 24 patients (44 ears). Results: The mean operative time for the microscopic technique was significantly shorter than that of the endoscopic technique (P < 0.05). No serious perioperative complications related to the techniques used occurred. Conclusions: In children, oto-endoscopic tube placement can be performed safely, but the duration of endoscopic tube placement is not shorter than that of microscopic tube placement.