Feedback Enhances Training and Elicits Biometric Responses in Novel Flexible Nasolaryngoscopy Model

To demonstrate the feasibility and impact of auditory feedback in flexible fiberoptic nasolaryngoscopy (FNL) training with a novel model incorporating audio triggers based on known anatomical loci of negative patient feedback.

This proof-of-concept study used a CT-based 3D-printed and silicone-casted model of nares to mainstem bronchi to teach FNL during an otolaryngology simulation training. The spatially tracked laryngoscope tip triggered simulated responses (pain, gag, cough) when co-localized to specific anatomic landmarks: the nasal septum, epiglottis, and trachea. Participants wearing heart rate (HR) monitors completed three FNL trials, two without and one with auditory patient responses. Outcomes, stratified by prior trainee experience, included participant HR, survey-based changes in confidence, and assessment of auditory feedback utility.

Twenty-nine trainees ranging from medical students to fourth-year otolaryngology residents rated model realism and tactile experience 7.4 ± 1.6 and 6.9 ± 2.2, respectively, on a 10-point Likert scale (mean ± standard deviation). Average HR increased from resting baseline during all trials, decreased during the second trial, and increased in the final trial that included audio feedback (p = 0.02). The least-experienced participants reported the greatest change in confidence (novice: +175%, low: +165%, intermediate: +73%, experienced: +13%). All trainees felt auditory feedback added value and improved fidelity.

Heart rate increased from baseline during simulated FNL on a novel 3D-printed model, implying sympathetic activation and increased stress. HR decreased with repetition, implying improved comfort, but increased with simulated auditory patient responses, suggesting that patient feedback can increase trainee attentiveness. Future studies may analyze the widespread implementation of this model for multi-disciplinary learners.

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