Background: The aim of this paper is to analyze the results of virtual reality (VR) antromastoidectomy simulation training and the transferability of the obtained skills to real temporal bone surgery. Methods: The study was conducted prospectively on a group of 10 physicians, and was composed of five VR simulation training sessions followed by live temporal bone surgery. The quality of performance was evaluated with a Task-Based Checklist (TBC) prepared by John Hopkins Hospital. Additionally, during every VR session, the number and type of mistakes (complications) were noted. Results: The quality of performance measured by the TBC increased significantly during consecutive VR sessions. The mean scores for the first and fifth sessions were 1.84 and 4.27, respectively (p < 0.001). Furthermore, the number of mistakes in consecutive VR sessions was gradually reduced from 11 to 0. During supervised surgery, all the participants were able to perform at least part of an antromastoidectomy, and the mean TBC score was 3.57. There was a significant strong positive correlation between the individual results of the fifth VR session and the individual results of supervised surgery in the operating room (rp = 0.89, p = 0.001). Conclusions: Virtual reality for temporal bone training makes it possible to acquire surgical skills in a safe environment before performing supervised surgery. Furthermore, the individual final score of virtual antromastoidectomy training allows a prediction of the quality of performance in real surgery.

Virtual reality (VR) may be a good alternative for cadaveric temporal bone surgical dissection courses, which are an important part of otolaryngology resident’s training. The aim of the study was to assess the VR temporal bone surgery simulator in an antromastoidectomy simulation. The VR system was based on the Geomagic Touch Haptic Device from 3D System. The research was designed as a prospective study, with three sessions of VR simulation training. The group of four ENT specialists unexperienced in otosurgery and 11 otorhinolaryngology residents performed a series of virtual dissections of a VR temporal bone model. Two experts with a broad experience in ear surgery participated in the study as supervisors for all the participants. At the end of each session, the experts controlled the accuracy of the simulated surgery performance assigning positive points for each correctly performed step and negative points for each mistake. After each session, participants of the study were asked to fill in the questionnaire concerning their impression of a VR system simulation. The evaluation of every simulation (total score) was based on the duration of a VR session, the quality of performance (positive points) and the number of mistakes (negative points). During consecutive VR sessions, evident shortening of the length of performance, as well as an improvement in the quality of performance and reduction in mistakes, was observed. Sixty percent of study participants answered that signaling damage to the critical elements was good (40%—sufficient), and 67% assessed that they had made a progress in consecutive sessions. After three sessions, 100% of participants indicated higher self-confidence in relation to their own surgical skills. Also, all the participants indicated that VR training should be included in a routine educational program for medical students. VR training provides a structured, safe and supportive environment to familiarize oneself with complex anatomy and practical skills.

The goal of this study is to assess speech comprehension and listening effort by means of pupillometry, in patients with bone-anchored hearing system (BAHS). The study was performed prospectively in a group of 21 hearing-impaired adults, unilaterally implanted with BAHS Ponto. Listening effort was compared in patients wearing two sound processors (Oticon Medical AB, Askim, Sweden): Ponto 3 SuperPower (P3SP) and Ponto Pro (PP). Every patient was invited to two visits, separated by a 3-month break. The first session was to establish the noise level needed to obtain 95% correct sentence recall in the hearing in noise test (HINT), when speech is presented at 70 dB SPL. During the second session, pupillometry, with the use of the above-mentioned conditions, was performed. The mean HINT scores obtained during the second visit were 96.3% for PP and 97.7% for P3SP (p = 0.9863). In pupillometry, no significant differences were found for average PPD (peak pupil dilation; p = 0.3247), average peak pupil dilation timing (p = 0.527) and for pupil dilation growth curves with both processors. The findings of this study suggest that BAHS users allocate similar listening effort with PP and P3SP when processing speech-in-noise at a sound pressure level not saturating Ponto Pro and at a fixed performance level of 95%. This finding applies to the patients who meet the qualification criteria for bone conduction devices and have BC in situ threshold average below 45 dB HL.