Objective Chronic otitis media with anterior perforation is a challenging condition to treat with a microscope especially if the canal is narrow or has overhang. The endoscope provides the advantage of wide-angle view and transcanal access avoiding postaural approach and canaloplasty. The aim of this study was to compare the anatomical, functional outcomes, and surgical duration between endoscopic and microscopic type I tympanoplasty performed for anterior perforation Design Prospective comparative study Setting Tertiary Referral Hospital Participants A total of 100 cases with anterior perforations were enrolled which was divide into two groups, the microscopic (MT) and the endoscopic (ET) with 50 cases in each group. Main outcome measures Graft uptake rate, hearing outcomes and surgical durations were compared between the two groups. Results The graft uptake in MT and ET was 81.8% and 91.3% respectively, statistically not significant. The mean operative time for MT and ET was 68.68±18.79 minutes and 61.24 ± 11.18 minutes respectively with statistically significant difference (p-0.003). Hearing outcomes were improved after the surgery within the groups. However, there was no significant difference in the hearing between the groups. Conclusions The endoscopic tympanoplasty for anterior perforation provides superior visualization avoiding postaural incision and canaloplasty, with good graft closure rate, improved hearing. It also offers significantly faster completion of surgery than a microscope. Thus, with the endoscope, minimally invasive surgery can be performed. Key points • Anterior perforations are challenging condition and difficult to treat, carrying poor prognosis than central or posterior perforations. • Microscope provide straight line of vision, making it difficult to access anterior perforations. • Endoscope provides wide angle view, high magnification and high definition image which avoids postaural incision or canaloplasty for anterior perforation repair. • Transcanal Endoscopic ear surgery provides advantage of performing minimally invasive surgery. • It indirectly lessens the financial burden to the patient which is significant in the developing countries.