Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study

Abstract

Teaching methodologies for the anatomy of the middle ear have not been investigated greatly due to the middle ear's highly complex structure and hidden location inside of the temporal bone. The aim of this randomized study was to quantitatively compare the suitability of using microscope-and endoscope-based methods for teaching the anatomy of the middle ear. We hypothesize that the endoscopic approach will be more efficient compared to the microscopic approach. To answer the study questions, 33 sixth-year medical students, residents and otorhinolaryngology specialists were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection. After 2-4 weeks, the same educational curriculum was repeated using the other technique. The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P < 0.001). For the recall of anatomical structures during dissection, the endoscopic method outperformed the microscopic technique independently of the randomization or the prior training level of the attendees (P < 0.001). In conclusion, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge as compared to the microscopic approach. The participants subjectively preferred the endoscope for educational purposes. Anat Sci Educ 12: 507-517.

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

“…The consultants had a median surgical experience of 65 (range 4 to > 400) middle ear procedures (microscopic or endoscopic), whereas students and residents were inexperienced with regard to middle ear procedures. The same collective was also assessed regarding anatomical knowledge as previously reported [16]. Independently of the technique and the tasks we observed a statistically significant difference in the time required to complete the tasks between the three levels of training status ( F 2, 30 = 19.998, p < 0.001, = 0.571).…”

“…Moreover, the learner has the same perspective as the tutor in the endoscopic technique, which allows direct application of the observations and steps taught into his own surgical skills performance. Similarly, the benefits of these wide-angle views in teaching middle ear anatomy were previously reported [16]. Additionally, the lack of depth perception in the endoscopic technique did apparently not interfere with a cautious and precise manipulation of the instruments inside the middle ear.…”

“…On the other hand, we observe in Q5 that only well-trained surgeons benefit subjectively from the concomitant use of instrument and suction during the surgical tasks. These questions were part of the same questionnaire investigating the utility of the endoscopic approach regarding teaching middle ear anatomy [16]. However, no previously reported questions are included in this study.…”

Teaching Middle Ear Anatomy and Basic Ear Surgery Skills: A Qualitative Study Comparing Endoscopic and Microscopic Techniques

“…The detailed protocols used and the quantitative results can be found in the relevant publications. 7,8…”

Comparison of 3- vs 2-Dimensional Endoscopy Using Eye Tracking and Assessment of Cognitive Load Among Surgeons Performing Endoscopic Ear Surgery

“…ndoscopic ear surgery (EES) is gaining popularity among ear surgeons because it permits minimally invasive and functional surgery. Advantages of the endoscopic technique include (1) panoramic views of middle ear anatomy, 1 especially of the retrotympanum and hypotympanum [2][3][4] ; (2) enhanced magnification of very small anatomic structures, such as, a malformed stapes 5 ; (3) the possibility to use angled endoscopes 6 ; (4) preservation of healthy mastoid and middle ear mucosa 7 ; and (5) possible shorter operating times. 8 However, the endoscopic technique has its inherent challenges: (1) because it is a 1-handed technique, the learning curve is deemed to be slower and management of bleeding may be challenging, 9 (2) the narrow space available in the external auditory canal (EAC) limits the movements of surgical instruments, (3) disease inside the mastoid may not be addressed, and (4) until recently, high-definition camera systems were exclusively 2-dimensional (2D).…”