• Virtual reality simulation;
  • temporal bone surgery;
  • cadaveric temporal bone dissection;
  • objective assessment of temporal bone dissection;
  • Level of Evidence: 1b—individual randomized control trial.



This study aims to determine whether there are improved performances in cadaver temporal bone dissection after training using a VR simulator as a teaching aid compared with traditional training methods

Study design:

Randomized control trial.


Twenty participants with minimal temporal bone experience were recruited for this randomized control trial. After receiving the same didactic teaching they were randomized into two groups. The traditional group were to receive addition teaching via traditional teaching methods such as small group tutorials, videos, and models. The VR group received supervised teaching on the VR simulator. At the end of their teaching they were asked to perform a cadaveric temporal bone dissection and had their performance videoed and assessed by blinded assessors. The assessors judged the videos on four domains of assessments looking at the end product, injury size, overall performance, and technique. These assessments were based on the Welling's scale and OSATS.


The VR group performed significantly better in the end product of the dissection (VR 80% vs. traditional 45%, P-value <.001) and caused smaller injuries to anatomic structures (VR 19% vs. traditional 36%, P-value = .01). They also did better in the overall performance score (VR 55% vs. traditional 35%, P-value = .04) There were no differences in the technique score. There was a fair to moderate degree of interrater reliability between the assessors (kappa = 0.33–0.47; Intraclass correlation coefficient = 0.34–0.76).


Supervised teaching using a VR simulator seems to improve cadaveric temporal bone dissection performance compared with traditional teaching methods. Laryngoscope, 2011