Abstract Objectives To comparatively evaluate a low cost ‘frugal’ otoscope in low resource settings with a traditional device amongst health care workers in Malawi. Design A prospective, comparative, qualitative observational survey of healthcare workers opinions using 5-point Likert rating scales and tick box categories. Setting and Participants 25 mixed cadre health care workers from the Ear, Nose and Throat department of the in Malawi were recruited. Main outcome measures A 10-item survey questionnaire was used to compare the low cost ‘frugal’ otoscope with a traditional device. Outcomes measures used were ease of speculum attachment, handling, insertion, stability, the quality of view, colour, build, brightness, overall ease of use and their suitability for local work. Results The low cost ‘frugal’ otoscope scored statistically higher in overall combined performance, as well as in the remaining 4 out of the 9 attributes. Notably, 54.2% of users rated the low-cost device more suitable than the traditional device for use in low-middle income countries, 25% were equivocal and 20.8% preferred the traditional device. Conclusion This study deemed the low-cost frugal Arclight otoscope appropriate as a practical substitute for more expensive traditional otoscopes for the delivery of ENT services in low resource settings.