Search

Objective: To reveal the factors affecting the incidence of chorda tympani nerve (CTN) transection during middle ear surgery. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients We analyzed 232 ears (117 ears with cholesteatoma, 101 ears with chronic otitis media, and 14 ears with otosclerosis) that underwent tympanoplasty or stapes surgery during 2017–2020. Intervention: Eighty‐four ears underwent transcanal endoscopic ear surgery (TEES), 103 ears underwent microscopic ear surgery (MES), and 45 ears underwent surgery using both endoscopy and microscopy (Dual). Main Outcome Measure: To confirm CTN transection, intraoperative endoscopic/microscopic video images were evaluated. We used the same video images to determine the anatomical variation of the CTN course in the middle ear. Results: In 18 ears (7.8%: 6/84 TEES ears [7.1%], 6/103 MES ears [5.8%], and 6/45 Dual ears [13.3%]), the CTN was cut during middle ear surgery. There was no significant difference in CTN transection among groups. In cholesteatoma patients, stapes involvement resulted in a significantly higher CTN transection incidence. CTN anatomical variants such as the "Attached Short type" and "Ultrashort type" showed a significantly higher CTN transection incidence. Conclusion: Although endoscopic surgery did not reduce the incidence of CTN transection during middle ear surgery, pathological involvement of the stapes and CTN anatomical variants, such as the "Attached Short type" and "Ultrashort type," may increase this incidence. Preoperative evaluation of stapes involvement and anatomical location of the CTN course could help identify patients at greater risk for iatrogenic CTN transection. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to assess the anatomical appropriateness of a three‐dimensional (3D) printed pediatric middle ear model with a replaceable middle ear unit as an endoscopic ear surgery (EES) simulator. Methods: Single‐blinded, prospective, proof‐of‐concept study conducted in a simulation operative suite. A simulator was developed through segmentation of source images and multi‐material 3D printing. Subjects were asked to point to seven anatomical sites before and after a short anatomy presentation of a human middle ear photograph. They also filled out a survey about the feasibility of the model. Outcome variables included survey scores, pre‐anatomy lesson (PreAL) and post‐anatomy lesson (PostAL) quiz scores. Results: There were 24 participants (19 residents, 1 fellow, and 4 attendings), none with self‐reported proficiency in EES. The PreAL mean score was 4.42 and PostAL quiz mean score was 5.32 (average improvement of 43% [CI = 17%–70%]; p =.003). The higher the level of training, the higher the PreAL scores (0.55 points per year of training; p =.004). The subspecialty (otology, other, in‐training) was also associated with the PreAL scores (p =.004). Total survey score means were 22.8 (out of 30). Conclusion: The results of our study suggest that our model has adequate anatomical high fidelity to mimic a real, pediatric temporal bone for EES. As 3D printing technologies continue to advance, the quality of ear models has the potential to provide improved surgical training for pediatric EES. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]