Endoscopy is advantageous in many aspects of pediatric ear surgery, especially for tympanoplasty and cholesteatoma. The narrower pediatric meatus can restrict access for a totally endoscopic approach, but when possible, avoidance of an external incision is greatly appreciated by children. In cholesteatoma surgery, less residual disease and better hearing from ossicular preservation are achievable. Factors influencing selection of a totally endoscopic approach, or use of endoscopy as an adjunct are reviewed, along with tips to facilitate successful endoscopic surgery in children. The optimum approach will depend upon the extent of the disease, morphology of the child’s ear and surgeon’s experience.