Validation of a 3D-Printed Multimaterial Transcanal Tympanoplasty Simulator for Endoscopic Ear Surgery

Simulation is an interesting tool to improve the learning curve of total endoscopic ear surgery (TEES), but hard 3D-printed temporal bones, and cadaveric or animal models have their limits. The objective of this study was to establish face, content, and construct validity for a new 3D-printed multimaterial transcanal tympanoplasty simulator.

Temporal bone hard and soft tissues were segmented from an anonymized CT scan and 3D-printed using Polyjet multimaterial technology. Otolaryngology residents and TEES experts performed posterior perforation myringoplasty procedures on the simulator to assess face, content, and construct validity based on Likert scales. Residents also compared the model to cadaveric subjects.

Twelve residents and six experts gave overall 6.3/7 ± 1.4 and 6.0/7 ± 0.6 face validity scores ( p = 0.06) and overall 6.3/7 ± 0.8 and 6.0/7 ± 0.6 content validity scores ( p = 0.35), respectively. They indicated that the simulator should be incorporated into surgical training (6.5/7 ± 0.7 versus 5.5/7 ± 1.5; p = 0.17) and that it would be useful as a surgical competency evaluation tool (5.5/7 ± 0.8 versus 5.7/7 ± 1.4; p = 0.74). Overall satisfaction was similar to cadaveric subjects (3.7/7 ± 1.2). Construct validity, based on myringoplasty assessment scores for three experts, three fellows, and six residents, was 47.3/50 ± 0.6 versus 36.3/50 ± 3.2 versus 26.5/50 ± 5.3, respectively ( p = 0.009).

The multimaterial tympanoplasty simulator met acceptable face, content, and construct validity scores. This opens a new field for simulation training in otology, moving on from temporal bone drilling to transcanal procedures including TEES.