Hints and Pitfalls: How to Start Endoscopic Ear Surgery Training

The application of endoscopic technique to otologic and lateral skull base surgery represents an important alternative (exclusive or combined with the microscope) to the traditional microscopic approaches because of its great advantages in terms of visualisation of surgical corners and magnification of structures. However, endoscopic ear surgery is characterised by some specific technical and manual skills. Thus, a challenging learning curve, due to the one-handed technique and the necessity to develop hand-eye coordination, has to be considered. Similarly to the training programme for acquisition of surgical skills in endonasal anterior skull base surgery, published by Snyderman in 2007, a staged training programme for acquisition of surgical skills for endoscopic middle ear and lateral skull base surgery was proposed by our group. Five stages characterised by increasing complexity are described in our article, in order to follow a progression from lateral to medial, considering the coronal plane of the ear and the temporal bone. Comparatively, the development of the ovine model as an inexpensive, safe and reliable model for otologic surgery has progressively led to the application of the same training programme on this ex vivo model. Indeed, it represents an excellent setting to start manoeuvring the instruments for endoscopic ear surgery and to gain confidence in holding the endoscope and moving it inside the external auditory canal and tympanic cavity.