Alternative Modalities for Temporal Bone Training in Otolaryngology: A Systematic Review.

Objective: Critically appraise the current state of alternate temporal bone training techniques (virtual reality (VR) simulation, 3D-printed models, and mental practice (MP)) compared to traditional and cadaver methods. Databases Reviewed: PubMed, Cochrane, Web of Science. Methods: Search terms utilized "temporal bone training", "temporal bone surgical modalities", and "training modalities temporal bone surgery" with "3D", "rapid prototyp*", "stereolithography", "additive manufact*", "plaster", "VR", "virtual reality", "animal model", "animal temporal bone", and "synthetic" with "AND" for all literature. Exclusion criteria: non-ENT, non-English, and did not compare against alternative/traditional methods. Results: 10 studies were included with 322 participants (83.9% ENT residents and 16.1% medical students). Costs include the FDM printer ($300), materials ($5/3D model), and <$5,000 for freeware simulator hardware. The Welling scale was used in 50% of studies. Alternate methods produced comparable or improved assessment scores to traditional and cadaver methods. Injuries were reported in three VR studies, with two reported significantly lower injury scores in the intervention groups. Time to completion was not significantly different in four VR studies, except for one finding that the time to visualize the incus was significantly lower in the intervention group. Performance after MP was not statistically different. Conclusion: More data are needed to assess whether the alternate methods are comparable to cadaveric dissection in temporal bone training. 3D models and VR simulation demonstrate promising potential for novel trainees to acquire the basic skills and produce performance comparable to or significantly better than traditional methods of lectures, textbooks, CT images, and operative videos.