Tackling the Steep Climb – A Retrospective Evaluation of a Trainee’s Training Curve in Endoscopic Ear Surgery

By June 7, 2019

Endoscopic ear surgery (EES) is rapidly emerging as a mainstream surgical modality, with recent literature highlighting its advantages over traditional approaches. As more surgeons are adopting the technique, trainees in otolaryngology are in the midst of a ‘revolution’ in middle ear surgery. The aim of this study was to evaluate the learning curve of endoscopic tympanoplasty for an ENT trainee already trained in microscopic tympanoplasty.

Study design: Case Control Study
Setting: district general hospital
Patients: all patients that underwent tympanoplasty (endoscopic and microscopic), performed between 2016 – 2018 by single trainee surgeon trained in microscopic ear surgery. Patients with incomplete records were excluded. Patients were divided into control group (group A – microscopic surgery) and case groups (Group B – early EES, Group C – late EES).

Outcome measures: Primary – graft success. Secondary – hearing gain, duration of surgery.
Results: 60 EES and 36 control cases included. No significant difference in graft success rates or hearing gain between cases and control. Hearing gain was significantly better and duration of surgery shorter in group C compared to Group B.

Endoscopic tympanoplasty is equally effective and quicker than microscopic surgery. Duration of surgery decreases and hearing outcomes improve with a trainee’s experience. Results of EES remain stable along the learning curve for a trainee trained in microscopic surgery. this study provides much needed insight into the learning curve of trainee ENT surgeons who we hope will one day be at the helm of such revolutions in otolaryngology practice in the not so distant future.