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.