Objectives: In recent years, ear endoscopy has gradually become an important tool in ear surgery. This study further explored its application in ear surgery, to establish a surgical approach for semicircular canal obstruction (SOC) via the ear canal to control vertigo in Meniere's disease. Methods: With the approval of the ethics committee, recruitment started in June 2019. ​Four patients with Meniere's disease who had been treated conservatively for more than six months received SCO via an external ear canal approach under otoendoscopy and were followed for two years after surgery to assess the safety and efficacy of the procedure. Results The control of vertigo after the operation was satisfactory (100%), and the frequency and degree of vertigo were significantly improved. Tinnitus improved in 1 case (25%) and did not progress in the other 3 cases. Hearing loss did not progress in all patients. Postoperative walking instability occurred in 1 patient (25%), and there were no obvious complications. All patients reported significant improvements in their quality of life. Conclusions: SCO via the external auditory canal approach is safe, effective, easy to accept, and an alternative to conservative treatment of Meniere's disease with no actual hearing for more than 6 months.

Rationale: Semicircular canal occlusion (SCO) is used to treat vestibular vertigo with demonstrated efficacy. This study introduces a novel transcanal endoscopic approach for horizontal SCO to manage vertigo in refractory Meniere’s disease (MD). Patient concerns: Four patients with refractory MD, previously managed conservatively for over 6 months, presented with severe-to-profound hearing loss. Their vertigo symptoms progressively worsened and severely compromised quality of life. Diagnoses: All 4 patients met diagnostic criteria for definite MD with severe-to-profound hearing loss. Interventions: All patients underwent transcanal endoscopic horizontal SCO with a 12-month postoperative follow-up to evaluate clinical outcomes and procedural safety. Outcomes: Postoperative vertigo control was effective, demonstrating significant reductions in both attack frequency and symptom intensity. Subjective tinnitus improved in 1 patient and remained stable in the remaining 3. Hearing thresholds were preserved in all cases without progression. Transient postoperative disequilibrium occurred in 1 patient, resolving spontaneously without complications. Lessons: Transcanal endoscopic horizontal SCO represents a safe, effective, and clinically viable alternative to pharmacologic conservative management for refractory MD with severe-to-profound hearing loss persisting beyond 6 months.