Introduction:
Endoscopic ear surgery has come a long way since it was first described in 1990 (1) and is emerging as a mainstream surgical modality for the management of ear pathologies. One of the primary indications for endoscopic ear surgery is in the management of epitympanic and mesotympanic cholesteatoma (1,2). The endoscopic approach to management of cholesteatoma has been shown to be comparable to the more traditional microscopic approach in both safety and efficacy (3).
In a healthcare setting limited by resources, there is a need for justification for new approaches beyond safety and efficacy, with rationalisation of the expenditure involved. The ideal scenario would be achieving a health gain with a novel improvement in technology with minimal additional costs or, even better, with a cost saving. From an institutional perspective, the initial capital involved in setting up new technology often delays its implementation. An analysis of the initial and on-going direct costs, such as surgical, anaesthetic, hospital and equipment costs, would be helpful to justify implementation.
There is currently a dearth of literature on costs involved in endoscopic ear surgery (4,5), with no study in reviewed literature exploring the costs involved in a National Health Service (NHS) setting in the UK. Keeping the above in mind, this study aims to compare the direct costs of total endoscopic ear surgery with that of microscopic surgery, testing the null hypothesis that there is no difference in direct costs of total endoscopic ear surgery and microscopic ear surgery for attic cholesteatoma in a British National Health Service District General Hospital setting.