ObjectiveTo determine the outcomes and complications of endoscopic versus microscopic stapes surgery in patients with otosclerosis.Study DesignRandomized, single‐blinded clinical trial.MethodsPatients with otosclerosis who underwent either trans‐canal microscopic or endoscopic stapedotomy at a tertiary care hospital were compared. Thirty‐two patients were randomly divided into two groups using blocked randomization. Group A consisted of 16 patients who underwent trans‐canal microscopic stapedotomy, and group B consisted of 16 patients who underwent trans‐canal endoscopic stapedotomy. Postoperative vertigo, ear pain, and complications such as tympanic membrane perforation or chorda tympani nerve injury were evaluated. Three months postoperatively, patients were assessed for dysgeusia and hearing improvement.ResultsThe mean pre‐operative air‐bone gap (ABG) in the microscopic and endoscopic groups was 32.81 ± 6.82 and 30.00 ± 7.96, respectively. The mean improvement in the ABG was 25.45 ± 11.21 dB in the microscopic group and 23.21 ± 10.68 dB in the endoscopic group. Although both techniques showed improvement in auditory outcomes (p‐value <0.001), there were no statistical differences between the endoscopic and microscopic groups in the pre‐operative, post‐operative, and mean improvement of ABG (p‐value >0.05). There were no significant differences between the two methods in chorda tympanic nerve injury, vertigo scores, and the mean operating time (p‐value >0.05), but the mean pain score was higher in the microscopic group (2.56 ± 1.55 in the microscopic group versus 1.31 ± 0.70 in the endoscopic group) (p‐value = 0.003).ConclusionsEndoscopic stapes surgery can be a preferable alternative to conventional microscopic stapedotomy, as it yields similar hearing outcomes and lower pain scores.Level of Evidence2 Laryngoscope, 134:2395–2400, 2024