Ensuring adequate exposure and developing surgical skills for trainees has been an ongoing challenge. In this article, the authors reviewed the role of simulation and its role in developing skills in otologic surgery for trainees. Virtual-reality (VR) simulation models have been developed for myringotomy and ventilation tube insertion, mastoidectomy and advanced otologic procedures such as cochlear implants and ossiculoplasty. The authors found that there is a lack of evidence currently to support the use of VR for myringotomy and ventilation tube insertion. However, for temporal bone dissection, the authors found strong evidence to support the use of VR simulation for training. VR temporal bone drilling is accompanied with haptic interaction during drilling with force feedback and 3D graphics. The authors stressed the importance of having ongoing simulator-integrated tutoring and feedback for the trainee to improve. This method of learning was shown to improve learning curves, retention of procedural skills and significantly improved cadaveric dissection performance. The authors also discussed the importance of distributed learning where practice sessions should be short and spaced for optical learning. Currently, VR simulation models have a limited role for advanced otologic surgery such as cochlear implant and ossiculoplasty but they are being developed and improved. In summary, limitations of current training for surgical trainees include limited availability of human temporal bones, high cost of maintaining facilities and cost of prosthetic temporal bones. Whilst VR simulation overcomes this, it has its limitations, which include suboptimal realism and the lack of a validated assessment tool to assess learners’ performance. In conclusion, VR simulation has a role in training otologic surgery but should be used in conjunction with temporal bone dissection training. 

Otologic skills training.
Wiet G, Sorensen M, Andersen S.
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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