〔Abstract〕 Objective To study the clinical application value of endoscopic ossicular chain reconstruction in the treatment of chronic otitis media. Methods Sixty patients with chronic otitis media treated in Hechi People's Hospital from July 2020 to July 2021 were selected and divided into a control group and an observation group according to different treatment methods, with 30 cases in each group. The control group was treated with modified mastoidectomy combined with tympanoplasty, and the observation group was treated with endoscopic ossicular chain reconstruction. The clinical efficacy, surgical related indexes, audiological indexes [air conduction (AC), bone conduction (BC), air–bone gap (ABG)] and quality of life [Zurich chronic otitis media scale (ZCMEI)] were compared between the two groups, and the incidence of complications was compared between the two groups. Results There was no significant difference in clinical total effective rate between the two groups (P > 0.05). Dry ear rate and hearing improvement rate of the observation group were higher than those of the control group, dry ear time was shorter than that of the control group, tympanic membrane perforation rate was lower than that of the control group, the differences were statistically significant (P < 0.05). 60 days after surgery, AC and ABG in the two groups were lower than thoset before surgery, and AC and ABG in the observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). The complication rate of the observation group was lower than that of the control group, and the difference was statistically significant (P < 0.05). 60 days after surgery, the scores of symptoms of otitis media, psychosocial impact, subjective hearing level, medical resource use and ZCMEI total score of the two groups were lower than those before surgery, and the scores of the observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). Conclusion Endoscopic ossicular chain reconstruction is effective in the treatment of chronic otitis media patients, which can promote hearing recovery and shorten dry ear time.