Meg G. Keeley, MD, University of Virginia, Charlottesville, VA
BACKGROUND: Acute otitis media is the most common infection for which antibiotics are prescribed for children in the U.S. generating a well documented and substantial social and economic burden. The AAP/AAFP practice guideline recommends that, instruction in the proper examination of the child’s ear should begin with the first pediatric rotation in medical school and continue throughout postgraduate training. Continuing medical education should reinforce the importance of and retrain the clinician in the use of pneumatic otoscopy. Teaching these skills is a challenge in unwilling pediatric patients with joint viewing limited to video otoscopy and no existing models to simulate pneumatic otoscopy. The objective of this project was to develop a model to simulate common ear pathologies and how to perform related diagnostic techniques. METHODS: This project began as the development of an anatomical model to teach myringotomy and ear tube insertion. Prototyping was accomplished via 3-D software and hand sculpting with removable cartridges simulating the tympanic membrane and middle ear space. The interdisciplinary team of researchers from the Departments of Pediatrics, ENT and Biomedical Engineering at the University of Virginia then adapted this model for broader applications. Engineering and medical students have been involved in all stages of development. The head support has been modified for optimal positioning, more realistic materials have been incorporated to compose the soft tissue, an umbo/malleus was created to improve realism and a pressure gauge has been added to monitor pneumatic otoscopy. Replaceable cartridges with photos of normal and abnormal findings have been added to the teaching kit as well as foreign bodies to practice removal. CONCLUSIONS: The development and modification of this novel ear model has resulted in a versatile diagnostic and procedural teaching and assessment tool. The model has a broad target audience including students, residents and practicing physicians in many specialties. Additionally, this process has been a successful example of collaborative and translational research.