title: High-fidelity, inexpensive surgical middle ear simulator.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: George Washington University, Washington, District of Columbia 20006, USA. Monfared@gmail.com
authors.forename: Ashkan
authors.initials: A
authors.lastname: Monfared
authors.forename: Gerald
authors.initials: G
authors.lastname: Mitteramskogler
authors.forename: Simon
authors.initials: S
authors.lastname: Gruber
authors.forename: J Kenneth
authors.initials: JK
authors.lastname: Salisbury
authors.forename: Jurgen
authors.initials: J
authors.lastname: Stampfl
authors.forename: Nikolas H
authors.initials: NH
authors.lastname: Blevins
mesh_terms: D003054:Cochlear Implants / Q000191:economics; D017076:Computer-Aided Design; D004432:Ear, Middle / Q000033:anatomy & histology / Q000502:physiology*; D004867:Equipment Design; D006801:Humans; D007396:Internship and Residency; D008953:Models, Anatomic; D010036:Otolaryngology / Q000191:economics / Q000193:education*; D013506:Otologic Surgical Procedures / Q000191:economics / Q000193:education*; D010040:Otosclerosis / Q000628:therapy*