OBJECTIVE: Availability of surgical equipment and access to essential clinical services remains an important barrier to surgical care delivery, particularly in low- and middle-income countries (LMICs). This study aims to characterize the relative availability of essential equipment for otolaryngology-head and neck surgery (OHNS) care across World Bank income groups. METHODS: We conducted a cross-sectional survey on otolaryngologists' perceptions on the availability of surgical equipment and ancillary services in their respective practice settings per a 5-point Likert scale ranging from never to always available. The study was disseminated online via professional societies, personal contacts, and social media. Eligible participants included otolaryngologists from 194 WHO-recognized countries, which were grouped by World Bank income group classification and WHO region. RESULTS: The study involved 146 otolaryngologists, 69 (47%) from high-income countries (HICs), and 77 (53%) from LMICs. LMIC respondents were predominantly from the African and South-East Asian regions, which comprised 48% and 7.8% of all LMIC respondents, respectively. Results revealed significant differences in the availability of otologic, rhinologic, and endoscopic airway equipment between HICs and LMICs. Differences existed among commonly used equipment such as tympanomastoidectomy equipment and rigid bronchoscopy, to subspecialized equipment such as functional endoscopic sinus surgery equipment and cochlear implants ( CONCLUSIONS: The study highlighted key disparities in the availability of essential equipment for baseline OHNS care, especially for pediatric airway and otologic conditions. These results can be used to guide investment and advocacy efforts to improve specialty-specific surgical infrastructure relative to the global burden of OHNS diseases in low-resource settings. LEVEL OF EVIDENCE: 3.