Author(s)
Joshua A. Stramiello, MD
Stephanie Wong, MD
Omid Moshtaghi, MD
Alice Tor
Justin Ryan, PhD
Daniela Carvalho, MD,MMM
Affiliation(s)
University of California - San Diego, Department of Otolaryngology-Head & Neck Surgery; Rady Children's Hospital San Diego, Pediatric Otolaryngology; Rady Children's Hospital San Diego, 3D Innovations Lab
Abstract:
Introduction: The use of 3D printed surgical models for simulation training in otolaryngology has been shown to improve self-reported confidence and expertise in the associated practice. The purpose of this study is to assess the appropriateness of a multi-material, 3D printed pediatric middle ear model with a replaceable middle ear unit as an effective endoscopic ear surgery (EES) simulator.
Methods: This was a single-blinded, prospective, proof-of-concept study conducted in a simulation operative suite on January 8, 2021. The participants were ORL-HNS residents, fellows, and attendings from the San Diego area in California. Subjects were presented with the right ear surgical model with normal anatomy (intact ossicular chain) and asked to point to 7 anatomical sites before and after a short anatomy presentation of a left, human middle ear endoscopic photograph. The participants utilized a 30-degree 3mm scope (10cm) and a Rosen needle to point to the structures in the model. They also filled out a survey about the feasibility of the model. Outcome variables included survey scores, pre-anatomy (PA) and post-anatomy presentation quiz scores. Independent variables included level of training, resident post-graduate year, sub-specialty, and prior endoscopic ear surgery experience.
Results: There was a total of 24 participants (19 residents, 1 fellow, and 4 attendings), none with self-reported proficiency in EES. Total survey score means were 22.8 (out of 30). The PA mean score was 4.42 and post-anatomy quiz mean score was 5.3 (average improvement of 43% (CI=17%-70%); p=0.003). The higher the level of training, the higher the PA scores (0.55 points per year of training; p=0.004). The subspecialty (otology, other, in-training) was also associated with the PA scores (p=0.004).
Conclusions: The results of this study suggest that our 3D printed model has adequate high fidelity to mimic a real, pediatric temporal bone for EES. As 3D printing technologies continue to advance, the quality of ear models has the potential to provide improved surgical training for pediatric EES.