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Investigating the learning curve in endoscopic compared to microscopic myringotomy and ventilation tube insertion

Published online by Cambridge University Press:  19 June 2020

O Denton ,
A Daglish ,
L Smallman  and
S Fishpool
O Denton*
Affiliation:
Postgraduate Centre, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, UK
A Daglish
Affiliation:
Postgraduate Medical Education Centre, Royal Berkshire NHS Foundation Trust, Reading, UK
L Smallman
Affiliation:
School of Mathematics, Cardiff University, Wales, UK
S Fishpool
Affiliation:
Department of ENT, Cwm Taf Morgannwg University Health Board, Ynysmaerdy, Wales, UK
*
Author for correspondence: Dr Oliver Denton, Postgraduate Centre, St Mungo Building, Glasgow Royal Infirmary, 84 Castle St, GlasgowG4 0SF, Scotland, UK E-mail: dentonOG@doctors.org.uk
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Abstract

Objective

Rate of learning is often cited as a deterrent in the use of endoscopic ear surgery. This study investigated the learning curves of novice surgeons performing simulated ear surgery using either an endoscope or a microscope.

Methods

A prospective multi-site clinical research study was conducted. Seventy-two medical students were randomly allocated to the endoscope or microscope group, and performed 10 myringotomy and ventilation tube insertions. Trial times were used to produce learning curves. From these, slope (learning rate) and asymptote (optimal proficiency) were ascertained.

Results

There was no significant difference between the learning curves (p = 0.41). The learning rate value was 68.62 for the microscope group and 78.71 for the endoscope group. The optimal proficiency (seconds) was 32.83 for the microscope group and 27.87 for the endoscope group.

Conclusion

The absence of a significant difference shows that the learning rates of each technique are statistically indistinguishable. This suggests that surgeons are not justified when citing ‘steep learning curve’ in arguments against the use of endoscopes in middle-ear surgery.

Keywords

Learning CurveProspective StudiesOtologic Surgical ProceduresEndoscopesEar, Middle
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 6 , June 2020 , pp. 497 - 500
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Dr O Denton takes responsibility for the integrity of the content of the paper

This paper was the subject of an oral presentation at the 3rd World Congress on Endoscopic Ear Surgery, 14 June 2019, Boston, Massachusetts, USA.

References

Preyer, S. Endoscopic ear surgery – a complement to microscopic ear surgery. HNO 2017;65:29–34CrossRefGoogle ScholarPubMed
Kozin, ED, Lee, DJ. Basic principles of endoscopic ear surgery. Oper Tech Otolaryngol Head Neck Surg 2017;28:2–10CrossRefGoogle Scholar
Akyigit, A, Sakallıoglu, O, Karlidag, T. Endoscopic tympanoplasty. J Otol 2017;12:62–7CrossRefGoogle ScholarPubMed
Patel, J, Aiyer, RG, Gajjar, Y, Gupta, R, Raval, J, Suthar, PP. Endoscopic tympanoplasty vs microscopic tympanoplasty in tubotympanic CSOM: a comparative study of 44 cases. Int J Res Med Sci 2017;3:1953–7Google Scholar
Pothier, DD. Introducing endoscopic ear surgery into practice. Otolaryngol Clin North Am 2013;46:245–55CrossRefGoogle Scholar
Tseng, CC, Lai, MT, Wu, CC, Yuan, SP, Ding, YF. Comparison of the efficacy of endoscopic tympanoplasty and microscopic tympanoplasty: a systematic review and meta-analysis. Laryngoscope 2017;127:1890–6CrossRefGoogle ScholarPubMed
Martellucci, S, Pagliuca, G, de Vincentiis, M, De Virgilio, A, Fusconi, M, Gallipoli, C et al. Myringotomy and ventilation tube insertion with endoscopic or microscopic technique in adults: a pilot study. Otolaryngol Head Surg 2015;152:927–30CrossRefGoogle ScholarPubMed
Iannella, G, Magliulo, G. Endoscopic versus microscopic approach in stapes surgery: are operative times and learning curve important for making the choice? Otol Neurotol 2016;37:1350–7CrossRefGoogle ScholarPubMed
Doğan, S, Bayraktar, C. Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty. Eur Arch Otorhinolaryngol 2017;274:1853–8CrossRefGoogle ScholarPubMed
Tseng, C-C, Lai, M-T, Wu, C-C, Yuan, S-P, Ding, Y-F. Learning curve for endoscopic tympanoplasty: initial experience of 221 procedures. J Chin Med Assoc 2017;80:508–14CrossRefGoogle ScholarPubMed
Feldman, LS, Cao, J, Andalib, A, Fraser, S, Fried, GM. A method to characterize the learning curve for performance of a fundamental laparoscopic simulator task: defining “learning plateau” and “learning rate”. Surgery 2009;146:381–6CrossRefGoogle ScholarPubMed
Jesudason, WV, Smith, I. How we do it: the Bradford Grommet Trainer: a model for training in myringotomy and grommet insertion. Clin Otolaryngol 2005;30:371–3CrossRefGoogle Scholar
Mahalingham, S, Awad, Z, Tolley, NS, Khemani, S. Ventilation tube insertion simulation: a literature review and validity assessment of five training models. Clin Otolaryngol 2016;41:321–6CrossRefGoogle Scholar
R Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing, 2016Google Scholar
Huang, TY, Ho, KY, Wang, LF, Chien, CY, Wang, HM. A comparative study of endoscopic and microscopic approach type 1 tympanoplasty for simple chronic otitis media. J Int Adv Otol 2016;12:28–31CrossRefGoogle ScholarPubMed
Bakshi, SS. Letter to the Editor on “Myringotomy and ventilation tube insertion with endoscopic or microscopic technique in adults: a pilot study”. Otolaryngol Head Neck Surg 2015;153:1076CrossRefGoogle Scholar
Musbahi, O, Aydin, A, Al Omran, Y, Skilbeck, CJ, Ahmed, K. Current status of simulation in otolaryngology: a systematic review. J Surg Educ 2017;74:203–15CrossRefGoogle ScholarPubMed
Cordero, A, Benitez, S, Reyes, P, Vaca, M, Polo, R, Pérez, C et al. Ovine ear model for fully endoscopic stapedectomy training. Eur Arch Otorhinolaryngol 2015;272:2167–74CrossRefGoogle ScholarPubMed
van Dongen, KW, Verleisdonk, E-J, Schijven, MP, Broeders, IA. Will the Playstation generation become better endoscopic surgeons? Surg Endosc 2011;25:2275–80CrossRefGoogle ScholarPubMed