Face and content validation of a virtual reality temporal bone simulator

Asit Arora, Sam Khemani, Neil Tolley, Arvind Singh, James Budge, David A. Diaz Voss Varela, Howard W. Francis, Ara Darzi, Nasir I. Bhatti

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Objective. To validate the VOXEL-MAN TempoSurg simulator for temporal bone dissection. Study Design. Prospective international study. Setting. Otolaryngology departments of 2 academic health care institutions in the United Kingdom and United States. Subjects and Methods. Eighty-five subjects were recruited consisting of an experienced and referent group. Participants performed a standardized familiarization session and temporal bone dissection task. Realism, training effectiveness, and global impressions were evaluated across 21 domains using a 5-point Likert-type scale. A score of 4 was the minimum threshold for acceptability. Results. The experienced group comprised 25 otolaryngology trainers who had performed 150 mastoid operations. The referent group comprised 60 trainees (mean otolaryngology experience of 2.9 years). Familiarization took longer in the experienced group (P = .01). User-friendliness was positively rated (mean score 4.1). Seventy percent of participants rated anatomical appearance as acceptable. Trainers rated drill ergonomics worse than did trainees (P = .01). Simulation temporal bone training scored highly (mean score 4.3). Surgical anatomy, drill navigation, and hand-eye coordination accounted for this. Trainees were more likely to recommend temporal bone simulation to a colleague than were trainers (P = .01). Transferability of skills to the operating room was undecided (mean score 3.5). Conclusion. Realism of the VOXEL-MAN virtual reality temporal bone simulator is suboptimal in its current version. Nonetheless, it represents a useful adjunct to existing training methods and is particularly beneficial for novice surgeons before performing cadaveric temporal bone dissection. Improvements in realism, specifically drill ergonomics and visual-spatial perception during deeper temporal bone dissection, are warranted.

Original languageEnglish (US)
Pages (from-to)497-503
Number of pages7
JournalOtolaryngology - Head and Neck Surgery
Issue number3
StatePublished - Mar 2012


  • Mastoid surgery
  • Otology
  • Training
  • Virtual reality simulation

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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