title: Simulation model for transcervical laryngeal injection providing real-time feedback.
abstract: OBJECTIVE
  This study aimed to develop and evaluate a model for teaching transcervical laryngeal injections.
  
  
  METHODS
  A 3-dimensional printer was used to create a laryngotracheal framework based on de-identified computed tomography images of a human larynx. The arytenoid cartilages and intrinsic laryngeal musculature were created in silicone from clay casts and thermoplastic molds. The thyroarytenoid (TA) muscle was created with electrically conductive silicone using metallic filaments embedded in silicone. Wires connected TA muscles to an electrical circuit incorporating a cell phone and speaker. A needle electrode completed the circuit when inserted in the TA during simulated injection, providing real-time feedback of successful needle placement by producing an audible sound. Face validation by the senior author confirmed appropriate tactile feedback and anatomical realism. Otolaryngologists pilot tested the model and completed presimulation and postsimulation questionnaires.
  
  
  RESULTS
  The high-fidelity simulation model provided tactile and audio feedback during needle placement, simulating transcervical vocal fold injections. Otolaryngology residents demonstrated higher comfort levels with transcervical thyroarytenoid injection on postsimulation questionnaires.
  
  
  CONCLUSIONS
  This is the first study to describe a simulator for developing transcervical vocal fold injection skills. The model provides real-time tactile and auditory feedback that aids in skill acquisition. Otolaryngologists reported increased confidence with transcervical injection after using the simulator.
authors: Department of Surgery-Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Tiffiny A
authors: TA
authors: Ainsworth
authors: Department of Surgery-Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: James B
authors: JB
authors: Kobler
authors: Department of Radiology-Harvard Medical School, The Simulation Group, Massachusetts General Hospital, Cambridge, Massachusetts, USA.
authors: Gregory J
authors: GJ
authors: Loan
authors: Department of Surgery-Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA burns.james@mgh.harvard.edu.
authors: James A
authors: JA
authors: Burns
mesh_terms: D002983:Clinical Competence; D005246:Feedback; D006801:Humans; D007267:Injections; D007396:Internship and Residency; D007830:Larynx; D008953:Models, Anatomic; D010036:Otolaryngology / Q000193:education*
keywords: laryngology; larynx; motor speech disorders; neurological disorders; otolaryngology; vocal fold; voice disorders