George Washington University, Washington, District of Columbia 20006, USA.
Otol Neurotol. 2012 Dec;33(9):1573-7. doi: 10.1097/MAO.0b013e31826dbca5.
A high-fidelity, inexpensive middle ear simulator could be created to enhance surgical training that would be rated as having high face validity by experts.
With rapid prototyping using additive manufacturing technology (AMT), one can create high-resolution 3-dimensional replicas of the middle ear at low cost and high fidelity. Such a simulator could be of great benefit for surgical training, particularly in light of new resident training guidelines.
AMT was used to create surgical middle ear simulator (SMS) with 2 different materials simulating bone and soft tissue. The simulator is composed of an outer box with dimensions of an average adult external auditory canal without scutum and an inner cartridge based on an otosclerosis model. The simulator was then rated by otology experts in terms of face validity and fidelity as well as their opinion on the usefulness of such a device.
Eighteen otologists from 6 tertiary academic centers rated the simulator; 83.3% agreed or highly agreed that SMS has accurate dimensions and 66.6% that it has accurate tactile feedback. When asked if performance of stapedotomy with the SMS improves with practice, 46% agreed. As to whether practicing stapedotomy with the SMS translates to improvement with live surgery, 78% agreed with this statement. Experts' average rating of the components of SMS (of possible 5) was as follows: middle ear dimensions, 3.9; malleus, 3.7; incus, 3.6; stapes, 3.6; chorda tympani, 3.7; tensor tympani, 4.1; stapedius, 3.8; facial nerve, 3.7; and promontory, 3.5. Overall, 83% found SMS to be at least "very useful" in training of novices, particularly for junior and senior residents.
Most experts found the SMS to be accurate, but there was a large discrepancy in rating of individual components. Most found it to be very useful for training of novice surgeons. With these results, we are encouraged to proceed with further refinements that will strengthen the SMS as a training tool for otologic surgery.
可以创建一个高保真、低成本的中耳模拟器，以增强手术培训，该模拟器将被专家评为具有高表面有效性。
通过使用增材制造技术（AMT）进行快速原型制作，可以以低成本和高保真度创建中耳的高分辨率 3 维复制品。这种模拟器对于手术培训将非常有益，特别是考虑到新的住院医师培训指南。
使用 AMT 创建了具有两种不同材料的外科中耳模拟器（SMS），模拟骨骼和软组织。模拟器由一个外盒组成，尺寸为没有盾板的成人外耳通道，以及一个基于耳硬化症模型的内盒。然后，由 18 名来自 6 个三级学术中心的耳科专家根据表面有效性和保真度对模拟器进行评分，并对这种设备的有用性发表意见。
18 名耳科专家来自 6 个三级学术中心对模拟器进行了评分；83.3%的专家同意或非常同意 SMS 具有准确的尺寸，66.6%的专家同意它具有准确的触觉反馈。当被问及使用 SMS 进行镫骨切开术的操作是否随着练习而提高时，46%的专家表示同意。至于使用 SMS 进行镫骨切开术的练习是否能转化为实际手术的提高，78%的专家同意这一说法。专家对 SMS 的各个组件的平均评分（满分 5 分）如下：中耳尺寸，3.9；锤骨，3.7；砧骨，3.6；镫骨，3.6；鼓索神经，3.7；鼓膜张肌，4.1；镫骨肌，3.8；面神经，3.7；和后鼓室，3.5。总体而言，83%的专家认为 SMS 在培训新手方面至少“非常有用”，特别是对初级和高级住院医师。
大多数专家认为 SMS 非常准确，但对个别组件的评分存在较大差异。大多数专家认为它对新手外科医生的培训非常有用。有了这些结果，我们受到鼓舞，将进一步改进 SMS，使其成为耳科手术培训的工具。
