Purpose To map healthcare utilized by subjects with chronic otitis media, with or without cholesteatoma and perform a cost analysis to determine key drivers of healthcare expenditure. Methods A registry study of 656 adult subjects with chronic otitis media that underwent a middle ear surgery between 2014 and 2018. Healthcare contacts related to all publicly funded specialist ENT care, audiological care and primary care for a disease of the ear and mastoid process were extracted. The data are extracted from the Swedish National Patient Registry on subjects that reside in western Sweden. Results Subjects made 13,782 healthcare contacts at a total cost 61.1 million SEK (6.0 million EUR) between 2014 and 2018. The mean cost per subject was 93,075 SEK (9071 EUR) and ranged between 3971 SEK (387 EUR) and 468,711 SEK (45,683 EUR) per individual. In the most expensive quartile of subjects, mean cost was 192,353 SEK (18,747 EUR) over the 5-year period. These subjects made 3227 ENT contacts (roughly four each year) and 60% of total costs were associated with in-patient ENT care. Conclusion Patients with chronic otitis media are associated with high ENT resource utilization that does not diminish after surgical intervention and the disease places a long-term burden on healthcare systems. Significant costs are attributed to revision surgeries, indicating that these patients could be managed more effectively. In many such cases, reoperation cannot be avoided, especially due to recurrence of cholesteatoma. However, in some patients, when the indication for subsequent surgery is only hearing improvement, alternative options, such as hearing aids or implants, should also be considered. This is especially true in difficult cases, where revision ossiculoplasty is likely.

As recently demonstrated, a passive Gough-Stewart platform (a.k.a. hexapod) can be used to create a personalized surgical template to achieve minimally invasive access to the cochlea. The legs of the hexapod are manually adjusted to the desired length, which must be read off an analog scale. Previous experiments have shown that manual length setting of the hexapod’s legs is error-prone because of the imprecise readability of the analog scale. The objective of this study is to determine if integration of a linear encoder and digitally displaying the measured length help reduce the length setting error. Two experiments were conducted where users set the leg length manually. In both experiments, the users were asked to set the leg length to 20 nominal values using the whole setting range from 0 mm to 10 mm. In the first experiment, users had to rely only on the analog scale; in the second experiment, the electronic display additionally showed the user the actual leg length. Results show that the mean length setting error without using the digital display and only relying on the analog scale was (0.036 ± 0.020) mm (max: 0.107 mm) in contrast to (0.001 ± 0.000) mm (max: 0.002 mm) for the experiment with the integrated digital measurement system. The results support integration of digital length measurement systems as a promising tool to increase the accuracy of surgical template fabrication and thereby patients’ safety. Future studies must be conducted to evaluate if integration of a linear encoder in each of the six legs is feasible.

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