Skip to main content Accessibility help

Direct cost comparison of totally endoscopic versus open ear surgery

  • N Patel (a1) (a2) (a3), A Mohammadi (a1) and N Jufas (a1) (a2) (a3)



Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting.


A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques.


Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy.


Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.


Corresponding author

Address for correspondence: Dr Nirmal Patel, Kolling Deafness Research Centre, Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia E-mail:


Hide All
1 Kozin, ED, Gulati, S, Kaplan, AB, Lehmann, AE, Remenschneider, AK, Landegger, LD et al. Systematic review of outcomes following observational and operative endoscopic middle ear surgery. Laryngoscope 2015;125:1205–14
2 Thomassin, JM, Inedjian, JM, Rud, C, Conciatori, J, Vilcoq, P. Otoendoscopy: application in the middle ear surgery [in French]. Rev Laryngol Otol Rhinol (Bord) 1990;111:475–7
3 Tarabichi, M. Endoscopic management of acquired cholesteatoma. Am J Otol 1997;18:544–9
4 Presutti, L, Gioacchini, FM, Alicandri-Ciufelli, M, Villari, D, Marchioni, D. Results of endoscopic middle ear surgery for cholesteatoma treatment: a systematic review. Acta Otorhinolaryngol Ital 2014;34:153–7
5 Smith, KA, Rudmik, L. Cost collection and analysis for health economic evaluation. Otolaryngol Head Neck Surg 2013;149:192–9
6 Yung, MW, Oates J. The learning curve in stapes surgery and its implication for training. In: Arnold, W, Häusler, R, eds. Otosclerosis and Stapes Surgery. Basel: Karger, 2007;361–9
7 Buchman, CA, Chen, DA, Flannagan, P, Wilberger, JE, Maroon, JC. The learning curve for acoustic tumor surgery. Laryngoscope 1996;106:1406–11
8 Patel, N, Shelton, C. The surgical learning curve in aural atresia surgery. Laryngoscope 2007;117:6773
9 Sheehy, JL, Patterson, ME. Intact canal wall tympanoplasty with mastoidectomy. A review of eight years’ experience. Laryngoscope 1967;77:1502–42
10 Scott, A, De, R, Sadek, SA, Garrido, MC, Courteney-Harris, RG. Temporal bone dissection: a possible route for prion transmission? J Laryngol Otol 2001;115:374–5



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed