Purpose To develop a time-efficient automated segmentation approach that could identify critical structures in the temporal bone for visual enhancement and use in surgical simulation software. Methods An atlas-based segmentation approach was developed to segment the cochlea, ossicles, semicircular canals (SCCs), and facial nerve in normal temporal bone CT images. This approach was tested in images of 26 cadaver bones (13 left, 13 right). The results of the automated segmentation were compared to manual segmentation visually and using DICE metric, average Hausdorff distance, and volume similarity. Results The DICE metrics were greater than 0.8 for the cochlea, malleus, incus, and the SCCs combined. It was slightly lower for the facial nerve. The average Hausdorff distance was less than one voxel for all structures, and the volume similarity was 0.86 or greater for all structures except the stapes. Conclusions The atlas-based approach with rigid body registration of the otic capsule was successful in segmenting critical structures of temporal bone anatomy for use in surgical simulation software.

The FESS simulator uses both visual and haptic feedback to create a virtual reality environment to teach paranasal sinus anatomy and basic endoscopic sinus surgery techniques to ear, nose, and throat residents. The results of the current study showed that the haptic device was accurate in and of itself, within its current physical limitations, and that the isosurface-based simulator was preferred.

Objectives: (1) Determine simulation resources available within United States otolaryngology training institutions. (2) Determine current involvement in simulation within otolaryngology training programs. (3) Gauge interest in advancing simulation for training and assessment. Methods: A voluntary survey was sent to 104 program directors. The introduction provided a broad definition of simulation. Responses were collected between March 21 and April 5, 2013. Descriptive results are presented. Results: Responses were received for 43 (41%) of the surveys. A total of 39 of 43 respondents (91%) have a simulation center or program at their institution. A total of 34 of 43 respondents (79%) have onsite simulation, 32 (74%) have models, manikins, or other devices, and 25 (58%) have staff resources within their institution. A total of 8 of 43 respondents (19%) have extensive, 26 (60%) have limited, and 8 (19%) have no otolaryngology simulation activity at their institution. The most common applications of simulation within otolaryngology are emergency management (23 of 43 respondents; 53%) and otology (21 of 43; 49%). All 31 respondents use simulation for clinical training (100%), 11 (33%) for proficiency, and 7 for mastery (21%). Three of 36 (22%) use extensive, 12 (33%) limited, and 21 (58%) no simulation in research. None of 34 use simulation for otolaryngology credentialing, although 2 (6%) use simulation for advanced cardiac life support credentialing. A total of 31 of 37 respondents (84%) are interested in participating in multicenter trials of simulation initiatives. Conclusions: Simulation resources are widely available in otolaryngology training institutions. Survey respondents report limited but widespread participation in simulation activity, and widespread interest in participating in simulation trials.

Synopsis This review presents a summary of the current activity of simulation training for otologic skills. Simulation training has been demonstrated in a large spectrum of skills from simple otoscopy to advanced temporal bone surgical procedures and these are individually addressed. There is a wide variety of educational approaches, assessment tools and simulators in use including simple low cost task trainers to complex computer based virtual reality systems. A systematic approach to otologic skills training using adult learning theory concepts such as repeated and distributed practice, self-directed learning, and mastery learning is necessary for these educational interventions to be effective. Future directions include development of valid, universally accepted measures of performance to assess efficacy of simulation training interventions and for complex procedures, improvement in fidelity based on the educational goals for the particular skill.