A model for instruction in myringotomy and grommet insertion

Current Evidence for Simulation-Based Training and Assessment of Myringotomy and Ventilation Tube Insertion: A Systematic Review

OBJECTIVE

Myringotomy and ventilation tube insertion (MT) is a key procedure in otorhinolaryngology and can be trained using simulation models. We aimed to systematically review the literature on models for simulation-based training and assessment of MT and supporting educational evidence.

DATABASES REVIEWED

PubMed, Embase, Cochrane Library, Web of Science, Directory of Open Access Journals.

METHODS

Inclusion criteria were MT training and/or skills assessment using all types of training modalities and learners. Studies were divided into 1) descriptive and 2) educational interventional/observational in the analysis. For descriptive studies, we provide an overview of available models including materials and cost. Educational studies were appraised using Kirkpatrick's level of educational outcomes, Messick's framework of validity, and a structured quality assessment tool.

RESULTS

Forty-six studies were included consisting of 21 descriptive studies and 25 educational studies. Thirty-one unique physical and three virtual reality simulation models were identified. The studies report moderate to high realism of the different simulators and trainees and educators perceive them beneficial in training MT skills. Overall, simulation-based training is found to reduce procedure time and errors, and increase performance as measured using different assessment tools. None of the studies used a contemporary validity framework and the current educational evidence is limited.

CONCLUSION

Numerous simulation models and assessment tools have been described in the literature but educational evidence and systematic implementation into training curricula is scarce. There is especially a need to establish the effect of simulation-based training of MT in transfer to the operating room and on patient outcomes.

Interactive computer-based simulator for training in blade navigation and targeting in myringotomy

A virtual-reality simulator was developed for the training of Otolaryngology (Ear-Nose-Throat) surgical residents to perform myringotomy, a relatively common surgical procedure in which an incision is made in the eardrum mainly to treat middle-ear infections. The simulator presents the trainee with a three-dimensional (3D) virtual model of the ear that can be viewed through a mock surgical microscope consisting of a stereo visor mounted on a custom-designed stand. The trainee interacts with the virtual ear using a real myringotomy blade, the movements of which are tracked in real time using a stereo optical tracker. Interactions of the blade with virtual tissues are calculated and rendered on the visor using freely available physics and graphics software engines. Six experienced surgical residents and surgeons assessed the effectiveness of the simulator as a viable training tool by completing a questionnaire designed specifically for this study after using the simulator. Surgeons and residents were positively impressed by the simulator as a training tool and would recommend its use as part of training.

How we do it: the Bradford grommet trainer: a model for training in myringotomy and grommet insertion

Myringotomy and grommet insertion is the most common operative procedure in otological practice. We describe a simple, cheap and effective model for the junior trainee to develop the skills required for myringotomy and grommet insertion without compromising patient safety. As the materials required for our model are more readily available, it is more likely to gain widespread acceptance in ENT training.

A Laryngeal Dissection Station: Educational Paradigms in Phonosurgery

OBJECTIVES

To introduce a new tool for phonosurgical training and education. A multitude of innovations in complex laryngeal surgery has catalyzed new educational initiatives. Establishing dexterity in phonomicrosurgery is often difficult to achieve while working on patients because of the narrow margin for success. Furthermore, laryngoplastic phonosurgery and open partial laryngectomy require sophisticated knowledge of precise anatomic relationships, which can be difficult to express in images. Finally, many teaching programs do not have a high volume of these procedures, and there is a significant need to transmit this information in continuing education courses.

STUDY DESIGN

Prototype design.

METHODS

A laryngeal dissection station (LDS) was designed to facilitate the acquisition of high-level procedural skill sets for both transoral and transcervical techniques.

RESULTS

This LDS can be used in existing temporal-bone laboratories by using cadaveric larynges. A rectangular frame supports two adjustable holders, one for the larynx and one for the examining speculum of a laryngoscope. Procedures are performed with the larynx fixed in space by a novel fixator. Variation in position and orientation of the components affords simulation of both microlaryngoscopy and open surgery. The dissection station can accommodate virtually any laryngoscope, regardless of size or shape.

CONCLUSIONS

This training apparatus should facilitate laryngeal surgical instruction in residency training and continuing medical education. This device and others like it can help establish clinical competency in laryngology, should this become necessary in future educational models of residency training and recertification.

Simple model for teaching myringotomy and aural ventilation tube insertion

Aural ventilation tube insertion is the most common otological operation and is usually the first operation learnt by trainees. The limited supply of temporal bones as well as expensive commercial models hampers training in the procedure. This paper describes a simple solution making a model of the ear canal and drum out of materials available on an ENT ward.