Background: The aim of this paper is to analyze the results of virtual reality (VR) antromastoidectomy simulation training and the transferability of the obtained skills to real temporal bone surgery. Methods: The study was conducted prospectively on a group of 10 physicians, and was composed of five VR simulation training sessions followed by live temporal bone surgery. The quality of performance was evaluated with a Task-Based Checklist (TBC) prepared by John Hopkins Hospital. Additionally, during every VR session, the number and type of mistakes (complications) were noted. Results: The quality of performance measured by the TBC increased significantly during consecutive VR sessions. The mean scores for the first and fifth sessions were 1.84 and 4.27, respectively (p < 0.001). Furthermore, the number of mistakes in consecutive VR sessions was gradually reduced from 11 to 0. During supervised surgery, all the participants were able to perform at least part of an antromastoidectomy, and the mean TBC score was 3.57. There was a significant strong positive correlation between the individual results of the fifth VR session and the individual results of supervised surgery in the operating room (r_p = 0.89, p = 0.001). Conclusions: Virtual reality for temporal bone training makes it possible to acquire surgical skills in a safe environment before performing supervised surgery. Furthermore, the individual final score of virtual antromastoidectomy training allows a prediction of the quality of performance in real surgery.

Virtual reality (VR) may be a good alternative for cadaveric temporal bone surgical dissection courses, which are an important part of otolaryngology resident’s training. The aim of the study was to assess the VR temporal bone surgery simulator in an antromastoidectomy simulation. The VR system was based on the Geomagic Touch Haptic Device from 3D System. The research was designed as a prospective study, with three sessions of VR simulation training. The group of four ENT specialists unexperienced in otosurgery and 11 otorhinolaryngology residents performed a series of virtual dissections of a VR temporal bone model. Two experts with a broad experience in ear surgery participated in the study as supervisors for all the participants. At the end of each session, the experts controlled the accuracy of the simulated surgery performance assigning positive points for each correctly performed step and negative points for each mistake. After each session, participants of the study were asked to fill in the questionnaire concerning their impression of a VR system simulation. The evaluation of every simulation (total score) was based on the duration of a VR session, the quality of performance (positive points) and the number of mistakes (negative points). During consecutive VR sessions, evident shortening of the length of performance, as well as an improvement in the quality of performance and reduction in mistakes, was observed. Sixty percent of study participants answered that signaling damage to the critical elements was good (40%—sufficient), and 67% assessed that they had made a progress in consecutive sessions. After three sessions, 100% of participants indicated higher self-confidence in relation to their own surgical skills. Also, all the participants indicated that VR training should be included in a routine educational program for medical students. VR training provides a structured, safe and supportive environment to familiarize oneself with complex anatomy and practical skills.

Introduction: Transimpedance matrix measurement (TIM) is an electrophysiological measurement protocol of the impedance patterns of electrode contacts within the cochlea. Several studies have reported that TIM is an effective tool for the identification of abnormal electrode array placement. However, the normative values for properly inserted electrodes, as well as correlation of the TIM patterns with the electrode position, are not completely determined. Objectives: The first aim of this study is to establish normative values of TIM measurements obtained in children with proper electrode array insertion and tip fold-over, with proper inner ear anatomy and in congenital anomalies. The second aim of this study is to compare TIM measurements in Slim Modiolar (SM) and in Contour Advance (CA) electrodes, as their position is different according to the modiolus proximity. Methods: A total of 55 pediatric patients were included in the study and underwent cochlear implantation. 62 intraoperative measurements were conducted in this group—50 in children with normal inner ear anatomy and 12 in children with inner ear malformations. After each implantation, a plain x-ray was obtained. Results: There were clear statistically significant differences in TIM patterns in patients where electrode fold-over was confirmed and between SM and CA electrodes. Conclusions: TIM is a promising technique for intraoperative analysis of electrode placement. TIM patterns differ and correlate consistently with the different models of array implanted. This study is the first to report TIM patterns observed in children with normal inner ear anatomy and in inner ear malformations.

Introduction: Transimpedance Matrix Measurement (TIM) is an electrophysiological measurement proto-col of the impedance patterns of electrode contacts within the cochlea. Several studies have reported that TIM is an effective tool for the identification of abnormal electrode array placement. However, the norma-tive values for properly inserted electrodes as well as correlation of the TIM patterns with the electrode po-sition are not completely determined. Objectives: The first aim of this study is to establish normative values of TIM measurements obtained in chil-dren with proper electrode array insertion and tip fold over, with proper inner ear anatomy and in congen-ital anomalies. The second aim of this study is to compare TIM measurements in Slim Modiolar (SM) and in Contour Adavance (CA) electrodes, as they position is different according to the modiolus proximity. Methods: A total of 55 pediatric patients were included in the study and underwent cochlear implantation. 62 intraoperative measurements were conducted in this group – 50 in children with normal inner ear anatomy and 12 in children with inner ear malformations. After each implantation, plain x-ray was ob-tained. Results: There were clear statistically significant differences in TIM patterns in patients where electrode fold-over was confirmed and between SM and CA electrodes. Conclusions: TIM is a promising technique for intraoperative detection of abnormal electrode malinsertion as well as TIM patterns differ and correlate consistently with the different models of array implanted. This study is the first to report TIM patterns observed in children with normal inner ear anatomy and in inner ear malformations.