Learning Objectives: Objective: The introduction of new surgical techniques requires not only an evaluation of safety and clinical efficacy but also cost justification. Totally Endoscopic Ear Surgery (TEES) is a relatively new technique for managing chronic ear disease. The cost of specialised equipment required may be a barrier to implementation of the technique. This study aims to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma in an Australian private hospital setting. Study Design: A retrospective direct cost comparison from a hospital perspective, of TEES and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in the private tertiary setting was undertaken. Indirect and future costs were excluded. Methods: A cost comparison of anaesthetic set up and resources, operative set up and resources, average cost of running an operating theatre and cost of overnight admission was performed between the two techniques. Results: TEES has a mean reduction of AUD$2998.63 per operation from the hospital perspective when compared to an open procedure for attic cholesteatoma. Conclusion: Once the learning curve is achieved, TEES is more cost effective from a hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma. When indirect and future costs are considered as well, the economic gain of managing attic cholesteatoma endoscopically could possibly be even greater.

Objective: The introduction of new surgical techniques requires not only an evaluation of safety and clinical efficacy but also cost justification. Totally Endoscopic Ear Surgery (TEES) is a relatively new technique for managing chronic ear disease. The cost of specialised equipment required may be a barrier to implementation of the technique. This study aims to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma in an Australian private hospital setting.

Study Design: A retrospective direct cost comparison from a hospital perspective, of TEES and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in the private tertiary setting was undertaken. Indirect and future costs were excluded.

Methods: A cost comparison of anaesthetic set up and resources, operative set up and resources, average cost of running an operating theatre and cost of overnight admission was performed between the two techniques.

Results: TEES has a mean reduction of AUD$2998.63 per operation from the hospital perspective when compared to an open procedure for attic cholesteatoma.

Conclusion: Once the learning curve is achieved, TEES is more cost effective from a hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma. When indirect and future costs are considered as well, the economic gain of managing attic cholesteatoma endoscopically could possibly be even greater.