The field of otology and neurotology requires dissection at high magnification to ensure successful management of middle ear and mastoid disease and preservation of anatomic structures.

The ideal method of visualization should provide an unobstructed wide field of view and excellent ergonomics Box 1. Although the binocular microscope remains the cornerstone of surgical illumination and magnification, advances in video technology have enabled the use of heads-up techniques offered by endoscopes and exoscopes (Fig. 1).

The endoscope is ideal when utilizing small surgical corridors to access the hidden recesses of the middle ear.

The digital extracorporeal scope, or exoscope, is complementary to the endoscope and was designed to replace the operating microscope.

The exoscope can be used for transcanal, transmastoid, and craniotomy procedures requiring two handed dissection.

When compared with the microscope, these two heads-up modalities provide an immersive surgical view, greater depth of field, improved ergonomics, and enhanced compatibility with personal protective equipment (PPE).