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Estimate the available direct cost of cholesteatoma care in a university practice.Retrospective review of both physician and hospital financial data during a recent 3-year period.University-based tertiary referral medical system.Adults (≥18 yr old) with cholesteatoma.Financial information associated with both physician and hospital encounters were analyzed in a deidentified manner.Frequency and type of encounter, charges, collections, and payers were tabulated.Approximately 949 physician encounters (817 clinic, 130 surgical, and 2 inpatient) among 344 patients resulted in greater than $700, 000 in charges and greater than $211,000 in receipts (∼30% rate of collection). The average physician charge per patient per year was approximately $1,600. About 259 hospital encounters among 171 patients resulted in greater than $1.8 million in charges and greater than $520,000 in receipts (∼28% collection rate). The average hospital charge per patient per year was ∼$10,000. For physician encounters, managed care (37%) and Medicare (25%) were the most common payers, whereas 17% were uninsured. For hospital encounters, managed care (28%) and Medicare (14%) were the most common payers, whereas 24% were uninsured.The direct cost of care for patients with cholesteatoma is significant. The current treatment paradigm for this chronic disorder results in repeated health care system access and associated direct (and unmeasured indirect) expenses. Future treatment paradigms should be designed to improve disease-specific quality of life while mitigating this financial impact.