The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Steven Arild Wuyts Andersen - One of the best experts on this subject based on the ideXlab platform.
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standard setting of competency in Mastoidectomy for the cross institutional Mastoidectomy assessment tool
Annals of Otology Rhinology and Laryngology, 2020Co-Authors: Thomas Kerwin, Steven Arild Wuyts Andersen, Gregory J Wiet, Brad Hittle, Don Stredney, Paul De Boeck, Aaron C MoberlyAbstract:Objective:Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards of proficiency. T...
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decentralized virtual reality Mastoidectomy simulation training a prospective mixed methods study
European Archives of Oto-rhino-laryngology, 2019Co-Authors: Martin Frendo, Mads Solvsten Sorensen, Lars Konge, Ebbe Thingaard, Steven Arild Wuyts AndersenAbstract:Virtual reality (VR) training of Mastoidectomy is effective in surgical training—particularly if organized as distributed practice. However, centralization of practice facilities is a barrier to implementation of distributed simulation training. Decentralized training could be a potential solution. Here, we aim to assess the feasibility, use, and barriers to decentralized VR Mastoidectomy training using a freeware, high-fidelity temporal bone simulator. In a prospective, mixed-methods study, 20 otorhinolaryngology residents were given three months of local access to a VR Mastoidectomy simulator. Additionally, trainees were provided a range of learning supports for directed, self-regulated learning. Questionnaire data were collected and focus group interviews conducted. The interviews were analyzed using thematic analysis and compared with quantitative findings. Participants trained 48.5 h combined and mainly towards the end of the trial. Most participants used between two and four different learning supports. Qualitative analysis revealed five main themes regarding implementation of decentralized simulation training: convenience, time for training, ease of use, evidence for training, and testing. Decentralized VR training using a freeware, high-fidelity Mastoidectomy simulator is feasible but did not lead to a high training volume or truly distributed practice. Evidence for training was found motivational. Access to training, educational designs, and the role of testing are important for participant motivation and require further evaluation.
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performance metrics in Mastoidectomy training a systematic review
European Archives of Oto-rhino-laryngology, 2019Co-Authors: Fahd Alshahrestani, Mads Solvsten Sorensen, Steven Arild Wuyts AndersenAbstract:To investigate validity evidence, and strengths and limitations of performance metrics in Mastoidectomy training. A systematic review following the PRISMA guidelines. Studies reporting performance metrics in Mastoidectomy/temporal bone surgery were included. Data on design, outcomes, and results were extracted by two reviewers. Validity evidence according to Messick’s framework and level of evidence were assessed. The search yielded a total of 1085 studies from the years 1947–2018 and 35 studies were included for full data extraction after abstract and full-text screening. 33 different metrics on Mastoidectomy performance were identified and ranked according to the number of reports. Most of the 33 metrics identified had some amount of validity evidence. The metrics with most validity evidence were related to drilling time, volume drilled per time, force applied near vital structures, and volume removed. This review provides an overview of current metrics of Mastoidectomy performance, their validity, strengths and limitations, and identifies the gap in validity evidence of some metrics. Evidence-based metrics can be used for performance assessment in temporal bone surgery and for providing integrated and automated feedback in virtual reality simulation training. The use of such metrics in simulation-based Mastoidectomy training can potentially address some of the limitations in current temporal bone skill assessment and ease assessment in repeated practice. However, at present, an automated feedback based on metrics in VR simulation does not have sufficient empirical basis and has not been generally accepted for use in training and certification. 2a.
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mapping the plateau of novices in virtual reality simulation training of Mastoidectomy
Laryngoscope, 2017Co-Authors: Steven Arild Wuyts Andersen, Peter Trier Mikkelsen, Lars Konge, Per Cayethomasen, Mads Solvsten SorensenAbstract:Objectives/Hypothesis To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved. Study Design Prospective study. Methods Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of Mastoidectomy were included. Data were analyzed to identify key areas of difficulty as well as the procedures terminated without using all the time allowed. Results Novices had difficulty in avoiding drilling holes in the outer anatomical boundaries of the Mastoidectomy and frequently made injuries to vital structures such as the lateral semicircular canal, the ossicles, and the facial nerve. The simulator-integrated tutor function improved performance on many of these items, but overreliance on tutoring was observed. Novices also demonstrated poor self-assessment skills and often did not make use of the allowed time, lacking knowledge on when to stop or how to excel. Conclusion Directed, self-regulated VR simulation training of Mastoidectomy needs a strong instructional design with specific process goals to support deliberate practice because cognitive effort is needed for novices to improve beyond an initial plateau. Level of Evidence N/A. Laryngoscope, 2016
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the effect of self directed virtual reality simulation on dissection training performance in Mastoidectomy
Laryngoscope, 2016Co-Authors: Steven Arild Wuyts Andersen, Lars Konge, Per Cayethomasen, Soren Foghsgaard, Mads Solvsten SorensenAbstract:Objectives/Hypothesis To establish the effect of self-directed virtual reality (VR) simulation training on cadaveric dissection training performance in Mastoidectomy and the transferability of skills acquired in VR simulation training to the cadaveric dissection training setting. Study Design Prospective study. Methods Two cohorts of 20 novice otorhinolaryngology residents received either self-directed VR simulation training before cadaveric dissection training or vice versa. Cadaveric and VR simulation performances were assessed using final-product analysis with three blinded expert raters. Results The group receiving VR simulation training before cadaveric dissection had a mean final-product score of 14.9 (95 % confidence interval [CI] [12.9–16.9]) compared with 9.8 (95% CI [8.4–11.1]) in the group not receiving VR simulation training before cadaveric dissection. This 52% increase in performance was statistically significantly (P < 0.0001). A single dissection Mastoidectomy did not increase VR simulation performance (P = 0.22). Conclusions Two hours of self-directed VR simulation training was effective in increasing cadaveric dissection Mastoidectomy performance and suggests that Mastoidectomy skills are transferable from VR simulation to the traditional dissection setting. Virtual reality simulation training can therefore be employed to optimize training, and can spare the use of donated material and instructional resources for more advanced training after basic competencies have been acquired in the VR simulation environment. Level of Evidence NA. Laryngoscope, 2015
Clough Shelton - One of the best experts on this subject based on the ideXlab platform.
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tympanoplasty with intact canal wall Mastoidectomy for cholesteatoma long term surgical outcomes
Otolaryngology-Head and Neck Surgery, 2013Co-Authors: Kevin F Wilson, Ryan N Hoggan, Clough SheltonAbstract:ObjectiveWith different Mastoidectomy approaches available to the surgeon for treatment of cholesteatoma, we review long-term outcomes of intact canal wall (ICW) Mastoidectomy with tympanoplasty.St...
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tympanoplasty with intact canal wall Mastoidectomy for cholesteatoma long term surgical outcomes
Otolaryngology-Head and Neck Surgery, 2013Co-Authors: Kevin F Wilson, Ryan N Hoggan, Clough SheltonAbstract:ObjectiveWith different Mastoidectomy approaches available to the surgeon for treatment of cholesteatoma, we review long-term outcomes of intact canal wall (ICW) Mastoidectomy with tympanoplasty.Study DesignCase series with chart review.SettingAcademic medical center.Subjects and MethodsAll cases of cholesteatoma treated with ICW Mastoidectomy by the senior author over a period of 9 years for which at least 2 years of follow-up data exist. Patient and disease information was collected retrospectively and analyzed.ResultsOne hundred forty-eight patients with 156 affected ears were treated and followed for a median of 5.3 years (range, 2.1-14.8). The majority of the operations (144/156, 92%) were staged. Of those that were staged, 51/144 (35%) had residual cholesteatoma at the second stage. Thirteen patients (8%) had recurrence of their cholesteatoma, of which 6 required a subsequent canal wall down (CWD) Mastoidectomy.ConclusionsICW Mastoidectomy with tympanoplasty continues to be a successful treatment fo...
Mads Solvsten Sorensen - One of the best experts on this subject based on the ideXlab platform.
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decentralized virtual reality Mastoidectomy simulation training a prospective mixed methods study
European Archives of Oto-rhino-laryngology, 2019Co-Authors: Martin Frendo, Mads Solvsten Sorensen, Lars Konge, Ebbe Thingaard, Steven Arild Wuyts AndersenAbstract:Virtual reality (VR) training of Mastoidectomy is effective in surgical training—particularly if organized as distributed practice. However, centralization of practice facilities is a barrier to implementation of distributed simulation training. Decentralized training could be a potential solution. Here, we aim to assess the feasibility, use, and barriers to decentralized VR Mastoidectomy training using a freeware, high-fidelity temporal bone simulator. In a prospective, mixed-methods study, 20 otorhinolaryngology residents were given three months of local access to a VR Mastoidectomy simulator. Additionally, trainees were provided a range of learning supports for directed, self-regulated learning. Questionnaire data were collected and focus group interviews conducted. The interviews were analyzed using thematic analysis and compared with quantitative findings. Participants trained 48.5 h combined and mainly towards the end of the trial. Most participants used between two and four different learning supports. Qualitative analysis revealed five main themes regarding implementation of decentralized simulation training: convenience, time for training, ease of use, evidence for training, and testing. Decentralized VR training using a freeware, high-fidelity Mastoidectomy simulator is feasible but did not lead to a high training volume or truly distributed practice. Evidence for training was found motivational. Access to training, educational designs, and the role of testing are important for participant motivation and require further evaluation.
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performance metrics in Mastoidectomy training a systematic review
European Archives of Oto-rhino-laryngology, 2019Co-Authors: Fahd Alshahrestani, Mads Solvsten Sorensen, Steven Arild Wuyts AndersenAbstract:To investigate validity evidence, and strengths and limitations of performance metrics in Mastoidectomy training. A systematic review following the PRISMA guidelines. Studies reporting performance metrics in Mastoidectomy/temporal bone surgery were included. Data on design, outcomes, and results were extracted by two reviewers. Validity evidence according to Messick’s framework and level of evidence were assessed. The search yielded a total of 1085 studies from the years 1947–2018 and 35 studies were included for full data extraction after abstract and full-text screening. 33 different metrics on Mastoidectomy performance were identified and ranked according to the number of reports. Most of the 33 metrics identified had some amount of validity evidence. The metrics with most validity evidence were related to drilling time, volume drilled per time, force applied near vital structures, and volume removed. This review provides an overview of current metrics of Mastoidectomy performance, their validity, strengths and limitations, and identifies the gap in validity evidence of some metrics. Evidence-based metrics can be used for performance assessment in temporal bone surgery and for providing integrated and automated feedback in virtual reality simulation training. The use of such metrics in simulation-based Mastoidectomy training can potentially address some of the limitations in current temporal bone skill assessment and ease assessment in repeated practice. However, at present, an automated feedback based on metrics in VR simulation does not have sufficient empirical basis and has not been generally accepted for use in training and certification. 2a.
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mapping the plateau of novices in virtual reality simulation training of Mastoidectomy
Laryngoscope, 2017Co-Authors: Steven Arild Wuyts Andersen, Peter Trier Mikkelsen, Lars Konge, Per Cayethomasen, Mads Solvsten SorensenAbstract:Objectives/Hypothesis To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved. Study Design Prospective study. Methods Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of Mastoidectomy were included. Data were analyzed to identify key areas of difficulty as well as the procedures terminated without using all the time allowed. Results Novices had difficulty in avoiding drilling holes in the outer anatomical boundaries of the Mastoidectomy and frequently made injuries to vital structures such as the lateral semicircular canal, the ossicles, and the facial nerve. The simulator-integrated tutor function improved performance on many of these items, but overreliance on tutoring was observed. Novices also demonstrated poor self-assessment skills and often did not make use of the allowed time, lacking knowledge on when to stop or how to excel. Conclusion Directed, self-regulated VR simulation training of Mastoidectomy needs a strong instructional design with specific process goals to support deliberate practice because cognitive effort is needed for novices to improve beyond an initial plateau. Level of Evidence N/A. Laryngoscope, 2016
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the effect of self directed virtual reality simulation on dissection training performance in Mastoidectomy
Laryngoscope, 2016Co-Authors: Steven Arild Wuyts Andersen, Lars Konge, Per Cayethomasen, Soren Foghsgaard, Mads Solvsten SorensenAbstract:Objectives/Hypothesis To establish the effect of self-directed virtual reality (VR) simulation training on cadaveric dissection training performance in Mastoidectomy and the transferability of skills acquired in VR simulation training to the cadaveric dissection training setting. Study Design Prospective study. Methods Two cohorts of 20 novice otorhinolaryngology residents received either self-directed VR simulation training before cadaveric dissection training or vice versa. Cadaveric and VR simulation performances were assessed using final-product analysis with three blinded expert raters. Results The group receiving VR simulation training before cadaveric dissection had a mean final-product score of 14.9 (95 % confidence interval [CI] [12.9–16.9]) compared with 9.8 (95% CI [8.4–11.1]) in the group not receiving VR simulation training before cadaveric dissection. This 52% increase in performance was statistically significantly (P < 0.0001). A single dissection Mastoidectomy did not increase VR simulation performance (P = 0.22). Conclusions Two hours of self-directed VR simulation training was effective in increasing cadaveric dissection Mastoidectomy performance and suggests that Mastoidectomy skills are transferable from VR simulation to the traditional dissection setting. Virtual reality simulation training can therefore be employed to optimize training, and can spare the use of donated material and instructional resources for more advanced training after basic competencies have been acquired in the VR simulation environment. Level of Evidence NA. Laryngoscope, 2015
John L Dornhoffer - One of the best experts on this subject based on the ideXlab platform.
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therapeutic Mastoidectomy in the management of noncholesteatomatous chronic otitis media literature review and cost analysis
Otolaryngology-Head and Neck Surgery, 2016Co-Authors: Aaron Trinidade, Joshua Cody Page, John L DornhofferAbstract:ObjectiveDespite evidence that therapeutic Mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is unde...
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hearing aid tolerance after revision and obliteration of canal wall down Mastoidectomy cavities
Otology & Neurotology, 2013Co-Authors: Michael B Gluth, Adva B Friedman, Samuel R Atcherson, John L DornhofferAbstract:Objective To review the tolerance of hearing aid use after revision and obliteration of a previously unstable canal wall down Mastoidectomy cavity. Study design Retrospective case series. Setting Academic tertiary referral center. Patients Adults and children who underwent the described surgical procedure followed by attempted hearing aid use. Intervention(s) Surgical revision and obliteration of a chronically unstable canal wall down Mastoidectomy cavity and subsequent attempted use of a conventional, ear-level hearing aid. Main outcome measure(s) Stability of mastoid cavity after starting conventional hearing aid usage. Results From a review of 87 consecutive mastoid obliteration procedures performed on previously unstable open cavities, 20 ears in 19 subjects were identified for study inclusion. The indication for hearing aid use was mixed hearing loss in the majority of subjects (85%). Among included ears, 7 (35%) had at least one documented temporary period of hearing aid nonuse because of otorrhea; however, permanent discontinuation of hearing aid use in favor of bone-anchored hearing implant placement only occurred in 3 ears (15%). The mean follow-up from the start of hearing aid use was 49 months. Conclusion Although failures do exist, attempted use of a hearing aid after revision of an unstable canal wall down Mastoidectomy cavity seems feasible and generally well tolerated. However, the exact likelihood of achieving this result is yet uncertain, and hearing performance was not assessed in this study.
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success of cartilage grafting in revision tympanoplasty without Mastoidectomy
Otology & Neurotology, 2004Co-Authors: Ryan T Boone, Edward K Gardner, John L DornhofferAbstract:Objective: Candidates for revision tympanoplasty have experienced at least one failed attempt at repair of the tympanic membrane and are, therefore, at higher risk for subsequent repair failure. The adjunctive use of Mastoidectomy with tympanoplasty in those patients with noncholesteatomatous chronic otitis media is often used to decrease the risk for subsequent failure. However, at this institution, where we use cartilage tympanoplasty, Mastoidectomy is rarely performed in the absence of cholesteatoma. Our objective was to assess outcomes in patients undergoing revision tympanoplasty without Mastoidectomy using cartilage grafting. Study Design: We conducted a retrospective case review. Setting: Tertiary referral center. Patients: A total of 95 patients (42 female, 53 male; 5–81 yr of age) with a recurrent perforation who were treated surgically with cartilage tympanoplasty without Mastoidectomy were included in the chart review. Patients must have undergone at least one previous tympanoplasty without Mastoidectomy and had to have complete audiologic and chart follow up. Interventions: An underlay tympanoplasty technique using either a tragal cartilage–perichondrium island graft or palisaded concha cymba cartilage was used. Ossiculoplasty was performed as needed. Main Outcome Measure: Main outcome measures were incidence of reperforation of the grafted tympanic membrane, hearing result, and prevalence of other complications. Results: Successful closure without reperforation was obtained in 90 of 95 patients (94.7%). Average postoperative pure-tone average air–bone gap was 12.2 ± 7.3 dB compared with 24.6 ± 13.8 dB preoperatively (p < 0.001). Conclusions: Revision tympanoplasty with cartilage provided equivalent results to tympanoplasty with Mastoidectomy. Thus, Mastoidectomy may not be necessary in revision tympanoplasty in the absence of cholesteatoma if the repair is made with cartilage. Key Words: Cartilage graft—Mastoidectomy— Perforation—Revision tympanoplasty. Otol Neurotol 25:678–681, 2004.
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retrograde Mastoidectomy with canal wall reconstruction a follow up report
Otology & Neurotology, 2004Co-Authors: John L DornhofferAbstract:Objective:To evaluate long-term results of retrograde Mastoidectomy with canal wall reconstruction as a single-stage technique for cholesteatoma removal.Study Design:Retrospective case review.Setting:Tertiary referral center.Patients:Forty-six patients, representing 50 ears (20 pediatric and 30 adul
Kevin F Wilson - One of the best experts on this subject based on the ideXlab platform.
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tympanoplasty with intact canal wall Mastoidectomy for cholesteatoma long term surgical outcomes
Otolaryngology-Head and Neck Surgery, 2013Co-Authors: Kevin F Wilson, Ryan N Hoggan, Clough SheltonAbstract:ObjectiveWith different Mastoidectomy approaches available to the surgeon for treatment of cholesteatoma, we review long-term outcomes of intact canal wall (ICW) Mastoidectomy with tympanoplasty.St...
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tympanoplasty with intact canal wall Mastoidectomy for cholesteatoma long term surgical outcomes
Otolaryngology-Head and Neck Surgery, 2013Co-Authors: Kevin F Wilson, Ryan N Hoggan, Clough SheltonAbstract:ObjectiveWith different Mastoidectomy approaches available to the surgeon for treatment of cholesteatoma, we review long-term outcomes of intact canal wall (ICW) Mastoidectomy with tympanoplasty.Study DesignCase series with chart review.SettingAcademic medical center.Subjects and MethodsAll cases of cholesteatoma treated with ICW Mastoidectomy by the senior author over a period of 9 years for which at least 2 years of follow-up data exist. Patient and disease information was collected retrospectively and analyzed.ResultsOne hundred forty-eight patients with 156 affected ears were treated and followed for a median of 5.3 years (range, 2.1-14.8). The majority of the operations (144/156, 92%) were staged. Of those that were staged, 51/144 (35%) had residual cholesteatoma at the second stage. Thirteen patients (8%) had recurrence of their cholesteatoma, of which 6 required a subsequent canal wall down (CWD) Mastoidectomy.ConclusionsICW Mastoidectomy with tympanoplasty continues to be a successful treatment fo...