Simulators in endoscopic ear surgery: a systematic review of models, validation and educational utility

This study aimed to evaluate physical simulation models for endoscopic ear surgery including model types, validation methodology and educational outcomes.

A Preferred Reporting Items for Systematic reviews and Meta-Analyses compliant search of PubMed, Embase and the Cochrane Library was conducted to June 2025. Studies describing physical endoscopic ear surgery simulators with reported validation or educational outcomes were included.

Fourteen studies met inclusion criteria. Simulators comprised cadaveric animal heads, synthetic task trainers and single- and multi-material three-dimensional-printed models. Face validity was consistently high. Construct validity, assessed using Objective Structured Assessment of Technical Skills scores or timed tasks, was demonstrated in five studies. Content validity was reported in three studies. No study evaluated transfer validity. Educational outcomes included improvements in confidence, anatomical knowledge and task completion time.

Physical endoscopic ear surgery simulators show strong face validity and emerging construct validity, but evidence is limited by small, single-centre studies and methodological variability. Standardised validation and assessment of clinical transfer are needed to support integration into training pathways.