Department of Surgery (Otolaryngology), Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Vic, Australia.
Medical School, University of Birmingham, Birmingham, UK.
Clin Otolaryngol. 2020 Sep;45(5):746-753. doi: 10.1111/coa.13569. Epub 2020 May 25.
Cortical mastoidectomy is a common otolaryngology procedure and represents a compulsory part of otolaryngology training. As such, a specific validated assessment score is needed for the progression of competency-based training in this procedure. Although multiple temporal bone dissection scales have been developed, they have all been validated for advanced temporal bone dissection including posterior tympanotomy, rather than the task of cortical mastoidectomy.
The Melbourne Mastoidectomy Scale, a 20-item end-product dissection scale to assess cortical mastoidectomy, was developed. The scale was validated using dissections by 30 participants (10 novice, 10 intermediate and 10 expert) on a virtual reality temporal bone simulator. All dissections were assessed independently by three blinded graders. Additionally, all procedures were graded with an abbreviated Welling Scale by one grader.
There was high inter-rater reliability between the three graders (r = .9210, P < .0001). There was a significant difference in scores between the three groups (P < .0001). Additionally, there was a large effect size between all three groups: the differences between the novice group and both the intermediate group (P = .0119, η = 0.2482) and expert group (P < .001, η = 0.6356) were significant. The difference between the intermediate group and expert group again had a large effect size (η = 0.3217), but was not significant. The Melbourne Mastoidectomy Scale correlated well with an abbreviated Welling Scale (r = .8485, P < .0001).
The Melbourne Mastoidectomy Scale offers a validated score for use in the assessment of cortical mastoidectomy.
颅中窝乳突切除术是一种常见的耳鼻喉科手术，也是耳鼻喉科培训的必修部分。因此，这种手术的能力本位培训需要有一个专门的、经过验证的评估分数。虽然已经开发出了多种颞骨解剖量表，但它们都是针对包括后鼓室切开术在内的高级颞骨解剖进行验证的，而不是针对颅中窝乳突切除术的任务。
开发了一种 20 项的最终产品解剖量表——墨尔本乳突切除术量表，用于评估颅中窝乳突切除术。该量表通过 30 名参与者（10 名新手、10 名中级和 10 名专家）在虚拟现实颞骨模拟器上进行的解剖进行验证。所有的解剖都由三位盲评员独立评估。此外，一位评阅员还使用简化的 Welling 量表对所有手术进行了评分。
三位评阅员之间的评分具有很高的组内信度（r =.9210，P <.0001）。三个组之间的分数存在显著差异（P <.0001）。此外，三组之间的差异具有较大的效应量：新手组与中级组（P =.0119，η =.2482）和专家组（P <.001，η =.6356）之间的差异具有统计学意义。中级组与专家组之间的差异也具有较大的效应量（η =.3217），但没有统计学意义。墨尔本乳突切除术量表与简化的 Welling 量表相关性良好（r =.8485，P <.0001）。
墨尔本乳突切除术量表为评估颅中窝乳突切除术提供了一个经过验证的评分。
