Objective To compare the efficacy and safety of autologous ossicular bone and titanium alloy ossicular chain reconstruction (OCR) in endoscopic otoscopy. Methods It was collected for data of 78 patients with chronic otitis media (COM) in our hospital from January 2018 to January 2023. All patients underwent tympanoplasty and OCR treatment, who were divided into autogenous group (41 cases) and artificial group (37 cases) according to different OCR materials. The autologous group was treated with OCR of autologous auditory ossicles, and the artificial group was treated with OCR of titanium alloy auditory ossicles. It was analyzed for the surgical indexes, complications and recurrence within 1 year after surgery between the two groups. It was compared for the levels of air-conduction hearing, bone-conduction hearing and air-bone gap (ABG) in different frequency segments before surgery and 6 months after surgery. Results The operation time of autologous group was longer than that of artificial group, and the operation cost was lower than that of artificial group (P<0.05). The air conduction hearing and ABG of the two groups in different frequency segments (0.5, 1, 2 kHz) were decreased 6 months after operation compared with those before operation (P<0.05). However, there was no significant difference in air conduction hearing, bone conduction hearing and ABG level between different frequency segments of the autologous group and the artificial group 6 months after surgery (P>0.05). The complication rate of autologous group was lower than that of artificial group (P<0.05), but there was no difference in the recurrence rate within 1 year between the two groups (P>0.05). Conclusions The implantations of the autologous auditory ossicle tissue and the titanium alloy artificial auditory ossicle can effectively improve the hearing level of patients in the OCR operation for COM patients. Compared with the autologous group, the operation time of the artificial group is short, while the cost and complication rate of the autologous group are low.