Assessment of Middle Ear Anatomy and Basic Surgical Skills Teaching: A Randomized Comparison between Microscopy and Endoscopy

By June 10, 2019

Lukas Anschuetz1, Sören Huwendiek2, Daniel Stricker2, Abraam Yacoub1; Wilhelm Wimmer1,3, Marco Caversaccio1,3
1 Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland;
2 Institute of Medical Education, University of Bern, Bern, Switzerland;
3 ARTORG Center for Biomedical Engineering, Hearing Research Laboratory, University of Bern, Bern, Switzerland.

Introduction:
Due to the middle ear’s highly complex structure and hidden location inside of the temporal bone, teaching methodologies have not been investigated greatly. The aim of this randomized study was to quantitatively compare the suitability of using microscope- and endoscope-based methods for teaching anatomy and basic surgical skills of the middle ear.

Methods:
Thirty-three medical students, residents and otorhinolaryngology consultants were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection with teaching of surgical skills using Peyton’s approach followed by a structured assessment. After 2-4 weeks, the same educational curriculum was repeated using the other technique.

Results:
The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P<0.001). During skills assessment the endoscope provided shorter surgical time for novice surgeons. Moreover, the use of the endoscope was associated to less accidental injury to the ossicular chain.

Discussion:
The endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge. Moreover, the acquisition of surgical skills is improved in novice surgeons. The participants subjectively preferred the endoscope for educational purposes.