Objectives: Using transcanal endoscopic ear surgery to manage middle ear disease in children remains a controversial topic. The aim of this study was to compare the efficacy of transcanal endoscopic ear surgery between children and adults. Methods: This study consisted of 20 children (31 ears) and 86 adults (102 ears) with chronic otitis media who underwent transcanal endoscopic ear surgery between January 2014 and August 2016 at Taipei and Hsinchu Cathay General Hospital. Among these patients, 13 children (23 ears) and 23 adults (34 ears) had chronic otitis media with effusion, 4 children (5 ears) and 46 adults (51 ears) had chronic otitis media without cholesteatomas, and 3 children (3 ears) and 17 adults (17 ears) had cholesteatomas. The two groups were compared with respect to (1) surgical outcome, which included the rates of surgical success, hearing restoration, and postoperative complications, and (2) surgical time. Results: We observed no significant difference between pediatric and adult patients with regard to the rates of surgical success, postoperative hearing gain, and postoperative complications in all surgical procedures. As for ventilation tube insertion, the pediatric patients had shorter surgical time compared to adult patients. With respect to tympanoplasty, the pediatric group had a longer surgical time than adults did. Conclusions: Our study showed that transcanal endoscopic ear surgery can be successfully applied to manage various middle ear diseases in children.