Objective To analyze the clinical effect of middle ear surgery under otoscope in the treatment of otitis media. Methods A total of 40 patients with otitis media treated in our hospital from January 2018 to January 2019 were selected as the research objects. They were divided into the observation group (20 cases) and the control group (20 cases) according to the computer random allocation method. The observation group was given middle ear surgery, the control group used conventional treatment. The total effective rate, the total incidence rate of complication, and recurrence rate were compared between the two groups. Results The total effective rate of patients in the observation group was 95.00%, which was higher than 55.00% in the control group (P＜0.05). The total incidence rate of complications in the observation group was 5.00%, which was lower than 30.00% in the control group (P＜0.05). The recurrence rate of patients in the observation group was 10.00%, which was lower than 35.00% in the control group (P＜0.05). Conclusion The clinical effect of middle ear surgery under otoscope in the treatment of otitis media is significant, with high safety and low recurrence rate.