Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection.

OBJECTIVE: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods. BACKGROUND: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training. METHODS: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS. RESULTS: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance. CONCLUSIONS: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.

Priorities in the Neurotology Fellowship Match: A Survey Study of Program Directors and Fellows.

OBJECTIVES: To ascertain motivations and priorities for neurotology fellowship applicants and program directors during the match process. METHODS: Anonymous online survey distributed to 20 fellowship program directors and 40 current and incoming neurotology fellows. A 5-point Likert scale was used to assess the priorities of fellowship applicants and program directors in the match process. RESULTS: Twenty-four of 40 (60%) current or incoming fellows and 14 of 20 (65%) program directors responded to the survey. Fellows rated surgical exposure and volume as their highest priorities. In addition to neurotology case load, fellows highly valued exposure to otologic surgery. Salary, call, and work/life balance were among the lowest rated factors among fellows. Program directors attached the highest priority to the applicant interview performance, followed by strength of letters of recommendation and quality of prior research. Ethnicity, sex, and likelihood of an applicant ranking a program highly were the lowest rated factors among program directors. CONCLUSION: Among neurotology fellows, operative case load and breadth of surgical exposure are highly valued components of accredited fellowship training. Among neurotology fellowship program directors, candidates' performance during the fellowship interview appears to be highly valued, more so than the strength of applicants' letters of recommendation or prior research credentials.

Evolution of Otology and Neurotology Education in the United States.

: A brief history of the evolution of Otology and Neurotology training in the United States is presented. The development of the Neurotology Fellowship accreditation process by the Accreditation Council on Graduate Education and the certification of neurotology fellows by the American Board of Otolaryngology is outlined.

A simple assessment tool for evaluation of cadaveric temporal bone dissection.

EDUCATIONAL OBJECTIVE: Objective metrics in skilled-based educational courses allow trainees and instructors to assess performance and monitor progress. The objective is to validate a concise, easy-to-use instrument for assessment of resident skill during a timed cadaveric temporal-bone (CTB) dissection. STUDY DESIGN: Retrospective analysis. METHODS: An instrument was developed to assess resident performance on a yearly timed microdissection of CTB. Five neurotologists participated in the assessment. Each reviewer's score was compared to the score given by the senior neurotologist each year for every resident. Spearman's correlation analysis was then used to assess the reproducibility of the instrument in assessing resident performance. The ability of the instrument to distinguish among experienced and novice trainees and to demonstrate improvement with experience were also assessed. RESULTS: The instrument was created and used for 6 years. Thirty residents were assessed. Correlation of scores between the senior neurotologist and the other neurotologist together was very high (r = 0.883, P < 0.001). Three specific tasks distinguished novice from senior dissectors: posterior canal, opening the membranous labyrinth, and disruption of the ossicular chain. CONCLUSION: A new instrument for assessment of resident skill on CTB dissection is presented. The instrument is easy to use, and scores derived from it are consistent across reviewers. The new instrument distinguishes experienced trainees from novice trainees, is sensitive to individual experience, and has proved useful in providing trainees with objective performance measures. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:451-455, 2018.

Early practice: neurotology.

Besides technical and surgical proficiency, some of the most important skills for a young Neurotologist to refine include communication and critical thinking abilities. This Early Practice article provides perspectives on common challenges and career development from a current Neurotology fellow and his mentor.

Acceptance of neurotology board certification among leaders in the field.

INTRODUCTION: Neurotology board certification was born a decade ago and is available to otolaryngologists who specialize in clinical neurotology. The degree of participation in this voluntary program among leaders in the field has not been previously assessed. METHODS: The Web sites of ACGME accredited otolaryngology programs were used to identify chairpersons who self-identified as neurotologists. Past presidents of the American Neurotology Society (ANS) since 1997 were also evaluated. The participation of both groups in neurotology board certification (NC) was ascertained using the search tool available on the American Board of Otolaryngology Web site (aboto.org). RESULTS: Of the 26 chairmen (all were men) identified as neurotologists, 18 (69%) participated in NC. Ten of 13 past presidents (77%) of the ANS participated in NC. Combining the 2 groups, 28 (72%) of 39 leaders in neurotology in the United States participated in NC. CONCLUSION: Adoption of the NC process among leaders in the field of neurotology in the United States has been robust, despite the significant costs entailed in participation.