Endoscopic surgery of the inner ear may be a useful, minimally invasive approach to remove pathologic lesions and yet retain inner ear function. Several different endoscopic inner ear surgical entry sites and strategies that may help to preserve otologic function are described. These endoscopic surgical method alternatives are based on temporal bone studies, prior literature, and clinical patient experiences. Endoscopic inner ear surgery is a challenging, but potentially very useful method to address inner ear problems.