Learning curve of tympanoplasty type I

To determine the time required to train a surgeon to skillfully perform tympanoplasty type I.

From July 1, 2001 to December 31, 2006, 75 patients who underwent tympanoplasty type I were enrolled in this study. All of the procedures were performed by two surgeons trained in the same tertiary referral center. We stratified the patients into groups according to the surgeon level at the time of their surgery. We analyzed the operation time and surgical outcomes of these patients.

The average operation time of resident physicians was 116.36 min, which was significantly longer (p<0.0001) than that of the attending physicians (average 83.11 min). There was no statistical difference in surgical success rate and post-operative complication between the resident year and attending year groups. We stratified the patients according to surgeon years, from year 3 to year 7. The operation time of the 4th and the 5th year surgeons was not statistically different from that of 3rd year surgeons. However, the operation time of the 6th and 7th year surgeons was statistically shorter than that of 3rd year surgeons. There was no difference on surgical success rate and complications among all year groups.

A surgeon's years of experience could make the difference in terms of speed of operation. It takes 5 years for surgeons to reach a plateau in learning curve on the speed of performing tympanoplasty type I. We therefore conclude that it takes 5 years to train a surgeon for tympanoplasty type I.