Virtual reality myringotomy simulation with real-time deformation: Development and validity testing

Authors

  • Andrew K. Ho MESc,

    1. Biomedical Engineering Graduate Program, University of Western Ontario, London, Ontario, Canada
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  • Hussain Alsaffar MBBS,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
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  • Philip C. Doyle PhD,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
    2. Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
    3. School of Communication Sciences and Disorders, University of Western Ontario, London, Ontario, Canada
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  • Hanif M. Ladak PhD,

    1. Biomedical Engineering Graduate Program, University of Western Ontario, London, Ontario, Canada
    2. Department of Otolaryngology—Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
    3. Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
    4. Department of Electrical and Computer Engineering, University of Western Ontario, London, Ontario, Canada
    5. National Centre for Audiology University of Western Ontario, London, Ontario, Canada
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    • Hanif Ladak, PhD, and Sumit Agrawal, MD, are both senior authors of this article.

  • Sumit K. Agrawal MD, FRCSC

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
    2. Department of Electrical and Computer Engineering, University of Western Ontario, London, Ontario, Canada
    3. National Centre for Audiology University of Western Ontario, London, Ontario, Canada
    • Room B1-333, University Hospital, Department of Otolaryngology—Head and Neck Surgery, London Health Sciences Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada
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    • Hanif Ladak, PhD, and Sumit Agrawal, MD, are both senior authors of this article.


  • Presented at the Canadian Society of Otolaryngology—Head and Neck Surgery 65th Annual Meeting, Victoria, British Columbia, Canada, May 22–24, 2011.

  • This work was supported by a Natural Sciences and Engineering Research Council of Canada grant (NSERC). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Surgical simulation is becoming an increasingly common training tool in residency programs. The first objective was to implement real-time soft-tissue deformation and cutting into a virtual reality myringotomy simulator. The second objective was to test the various implemented incision algorithms to determine which most accurately represents the tympanic membrane during myringotomy.

Study Design:

Descriptive and face-validity testing.

Methods:

A deformable tympanic membrane was developed, and three soft-tissue cutting algorithms were successfully implemented into the virtual reality myringotomy simulator. The algorithms included element removal, direction prediction, and Delaunay cutting. The simulator was stable and capable of running in real time on inexpensive hardware. A face-validity study was then carried out using a validated questionnaire given to eight otolaryngologists and four senior otolaryngology residents. Each participant was given an adaptation period on the simulator, was blinded to the algorithm being used, and was presented the three algorithms in a randomized order.

Results:

A virtual reality myringotomy simulator with real-time soft-tissue deformation and cutting was successfully developed. The simulator was stable, ran in real time on inexpensive hardware, and incorporated haptic feedback and stereoscopic vision. The Delaunay cutting algorithm was found to be the most realistic algorithm representing the incision during myringotomy (P < .05). The Likert and visual analog scales had strong correlations, suggesting good internal reliability.

Conclusions:

The first virtual reality myringotomy simulator is being developed and now integrates a real-time deformable tympanic membrane that appears to have face validity. Further development and validation studies are necessary before the simulator can be studied with respect to training efficacy and clinical impact. Laryngoscope, 2012

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