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

Area of Science:

• Medical Education
• Surgical Simulation
• Otolaryngology

Background:

• Endoscopic ear surgery (EES) requires specialized training.
• Physical simulation models offer a potential solution for EES training.
• Evaluating the effectiveness of these simulators is crucial.

Purpose of the Study:

• To systematically evaluate physical simulation models for EES.
• To assess model types, validation methods, and educational outcomes.

Main Methods:

• A systematic review adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
• Searched PubMed, Embase, and Cochrane Library up to June 2025.
• Included studies reporting validation or educational outcomes for EES simulators.

Main Results:

• Fourteen studies were included, featuring diverse simulators (animal heads, synthetic trainers, 3D-printed models).
• High face validity was consistently reported; construct validity was shown in five studies.
• Educational outcomes included improved confidence, anatomical knowledge, and reduced task completion time; transfer validity was not evaluated.

Conclusions:

• Physical EES simulators exhibit strong face validity and developing construct validity.
• Evidence is limited by small studies and methodological inconsistencies.
• Standardized validation and transferability assessments are necessary for training integration.