Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T14:25:25.408Z Has data issue: false hasContentIssue false
  • English
  • Français

The future of otology

Published online by Cambridge University Press:  29 August 2019

R K Jackler  and
T A Jan
R K Jackler*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Stanford Ear Institute, Stanford University School of Medicine, California, USA
T A Jan
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Stanford Ear Institute, Stanford University School of Medicine, California, USA
*
Author for correspondence: Prof Robert K Jackler, Department of Otolaryngology – Head and Neck Surgery, Stanford Ear Institute, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA E-mail: jackler@stanford.edu Fax: +1 650 725 8502
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The field of otology is increasingly at the forefront of innovation in science and medicine. The inner ear, one of the most challenging systems to study, has been rendered much more open to inquiry by recent developments in research methodology. Promising advances of potential clinical impact have occurred in recent years in biological fields such as auditory genetics, ototoxic chemoprevention and organ of Corti regeneration. The interface of the ear with digital technology to remediate hearing loss, or as a consumer device within an intelligent ecosystem of connected devices, is receiving enormous creative energy. Automation and artificial intelligence can enhance otological medical and surgical practice. Otology is poised to enter a new renaissance period, in which many previously untreatable ear diseases will yield to newly introduced therapies.

Objective

This paper speculates on the direction otology will take in the coming decades.

Conclusion

Making predictions about the future of otology is a risky endeavour. If the predictions are found wanting, it will likely be because of unforeseen revolutionary methods.

Keywords

FutureOtologyArtificial IntelligenceRoboticsRegenerationHearing technology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 9 , September 2019 , pp. 747 - 758
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Prof R K Jackler takes responsibility for the integrity of the content of the paper

R K Jackler was The Journal of Laryngology & Otology 2019 Visiting Professor.

References

1Sioshansi, PC, Jackler, RK, Alyono, JC. Practice of otology during the first quarter century of the American Otological Society (1868–1893). Otol Neurotol 2018;39:S10–29Google Scholar
2Aronson, SH. The sociology of the telephone. Int J Comp Sociol 1971;12:153–67Google Scholar
3Mudry, A, Mills, M. The early history of the cochlear implant: a retrospective. JAMA Otolaryngol Head Neck Surg 2013;139:446–53Google Scholar
4Hughes, GB. The decline of ear surgery in the 21st century. Am J Otol 2000;21:1–2Google Scholar
5Jackler, RK. Please don't close the patent office yet. Am J Otol 2000;21:3–4Google Scholar
6McKenna, MJ. The future of otology. Am J Otol 2000;21:456Google Scholar
7Rodriguez-Ruiz, A, Lång, K, Gubern-Merida, A, Broeders, M, Gennaro, G, Clauser, P et al. Stand-alone artificial intelligence for breast cancer detection in mammography: comparison with 101 radiologists. J Natl Cancer Inst 2019. Epub 2019 Mar 5Google Scholar
8Esteva, A, Kuprel, B, Novoa, RA, Ko, J, Swetter, SM, Blau, HM et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature 2017;542:115–18Google Scholar
9Hashimoto, DA, Rosman, G, Rus, D, Meireles, OR. Artificial intelligence in surgery: promises and perils. Ann Surg 2018;268:70–6Google Scholar
10Verghese, A, Shah, NH, Harrington, RA. What this computer needs is a physician: humanism and artificial intelligence. JAMA 2018;319:19–20Google Scholar
11Petersen, S, Houston, S, Qin, H, Tague, C, Studley, J. The utilization of robotic pets in dementia care. J Alzheimers Dis 2017;55:569–74Google Scholar
12Ross, A. The Industries of the Future. New York: Simon & Schuster, 2017;304Google Scholar
13Ford, M. Rise of the Robots: Technology and the Threat of a Jobless Future. New York: Basic Books, 2016;334Google Scholar
14Fitzgerald, MB, Jackler, RK. Assessment of hearing during the early years of the American Otological Society. Otol Neurotol 2018;39:S30–42Google Scholar
15Canadian Agency for Drugs and Technologies in Health. Audiograms and Functional Auditory Testing to Assess Hearing Speech in Noise: A Review of the Clinical Evidence. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2015Google Scholar
16Vendrametto, T, McAfee, JS, Hirsch, BE, Riviere, CN, Ferrigno, G, De Momi, E. Robot assisted stapedotomy ex vivo with an active handheld instrument. Conf Proc IEEE Eng Med Biol Soc 2015;2015:4879–82Google Scholar
17Montes Grande, G, Knisely, AJ, Becker, BC, Yang, S, Hirsch, BE, Riviere, CN. Handheld micromanipulator for robot-assisted stapes footplate surgery. Conf Proc IEEE Eng Med Biol Soc 2012;2012:1422–5Google Scholar
18Yasin, R, O'Connell, BP, Yu, H, Hunter, JB, Wanna, GB, Rivas, A et al. Steerable robot-assisted micromanipulation in the middle ear: preliminary feasibility evaluation. Otol Neurotol 2017;38:290–5Google Scholar
19Jackler, RK. A regenerative method of tympanic membrane repair could be the greatest advance in otology since the cochlear implant. Otol Neurotol 2012;33:289Google Scholar
20Holmes, D. Eardrum regeneration: membrane repair. Nature 2017;546:S5Google Scholar
21Santa Maria, PL, Weierich, K, Kim, S, Yang, YP. Heparin binding epidermal growth factor-like growth factor heals chronic tympanic membrane perforations with advantage over fibroblast growth factor 2 and epidermal growth factor in an animal model. Otol Neurotol 2015;36:1279–83Google Scholar
22Cox, MD, Trinidade, A, Russell, JS, Dornhoffer, JL. Long-term hearing results after ossiculoplasty. Otol Neurotol 2017;38:510–15Google Scholar
23Kozin, ED, Kiringoda, R, Lee, DJ. Incorporating endoscopic ear surgery into your clinical practice. Otolaryngol Clin North Am 2016;49:1237–51Google Scholar
24Tarabichi, M. Endoscopic management of acquired cholesteatoma. Am J Otol 1997;18:544–9Google Scholar
25Poe, D, Anand, V, Dean, M, Roberts, WH, Stolovitzky, JP, Hoffmann, K et al. Balloon dilation of the eustachian tube for dilatory dysfunction: a randomized controlled trial. Laryngoscope 2018;128:1200–6Google Scholar
26Mak, I, Hayes, AR, Khoo, B, Grossman, A. Peptide receptor radionuclide therapy as a novel treatment for metastatic and invasive phaeochromocytoma and paraganglioma. Neuroendocrinology 2019. Epub 2019 Mar 12Google Scholar
27Synodos for NF2 Consortium, Allaway, R, Angus, SP, Beauchamp, RL, Blakeley, JO, Bott, M et al. Traditional and systems biology based drug discovery for the rare tumor syndrome neurofibromatosis type 2. PloS One 2018;13:e0197350Google Scholar
28Xu, Y, Xia, N, Lim, M, Tan, X, Tran, MH, Boulger, E et al. Multichannel optrodes for photonic stimulation. Neurophotonics 2018;5:045002Google Scholar
29Gantz, BJ, Dunn, CC, Oleson, J, Hansen, MR. Acoustic plus electric speech processing: long-term results. Laryngoscope 2018;128:473–81Google Scholar
30Kiringoda, R, Kozin, ED, Lee, DJ. Outcomes in endoscopic ear surgery. Otolaryngol Clin North Am 2016;49:1271–90Google Scholar
31Hunter, JB, Rivas, A. Outcomes following endoscopic stapes surgery. Otolaryngol Clin North Am 2016;49:1215–25Google Scholar
32Garneau, JC, Laitman, BM, Cosetti, MK, Hadjipanayis, C, Wanna, G. The use of the exoscope in lateral skull base surgery: advantages and limitations. Otol Neurotol 2019;40:236–40Google Scholar
33Barber, SR, Wong, K, Kanumuri, V, Kiringoda, R, Kempfle, J, Remenschneider, AK et al. Augmented reality, surgical navigation, and 3D printing for transcanal endoscopic approach to the petrous apex. OTO Open 2018;2:2473974X18804492Google Scholar
34McJunkin, JL, Jiramongkolchai, P, Chung, W, Southworth, M, Durakovic, N, Buchman, CA et al. Development of a mixed reality platform for lateral skull base anatomy. Otol Neurotol 2018;39:e1137–42Google Scholar
35Marroquin, R, Lalande, A, Hussain, R, Guigou, C, Grayeli, AB. Augmented reality of the middle ear combining otoendoscopy and temporal bone computed tomography. Otol Neurotol 2018;39:931–9Google Scholar
36Alyono, JC, Corrales, CE, Huth, ME, Blevins, NH, Ricci, AJ. Development and characterization of chemical cochleostomy in the Guinea pig. Otolaryngol Head Neck Surg 2015;152:1113–18Google Scholar
37Iyer, JS, Batts, SA, Chu, KK, Sahin, MI, Leung, HM, Tearney, GJ et al. Micro-optical coherence tomography of the mammalian cochlea. Sci Rep 2016;6:33288Google Scholar
38Monfared, A, Blevins, NH, Cheung, ELM, Jung, JC, Popelka, G, Schnitzer, MJ. In vivo imaging of mammalian cochlear blood flow using fluorescence microendoscopy. Otol Neurotol 2006;27:144–52Google Scholar
39Hasin, Y, Seldin, M, Lusis, A. Multi-omics approaches to disease. Genome Biol 2017;18:83Google Scholar
40Regev, A, Teichmann, SA, Lander, ES, Amit, I, Benoist, C, Birney, E et al. The human cell atlas. eLife 2017;6:e27041Google Scholar
41Cao, J, Spielmann, M, Qiu, X, Huang, X, Ibrahim, DM, Hill, AJ et al. The single-cell transcriptional landscape of mammalian organogenesis. Nature 2019;566:496–502Google Scholar
42Wang, J, Puel, J-L. Toward cochlear therapies. Physiol Rev 2018;98:2477–522Google Scholar
43Mehta, D, Noon, SE, Schwartz, E, Wilkens, A, Bedoukian, EC, Scarano, I et al. Outcomes of evaluation and testing of 660 individuals with hearing loss in a pediatric genetics of hearing loss clinic. Am J Med Genet A 2016;170:2523–30Google Scholar
44Hereditary Hearing Loss Homepage. In: https://hereditaryhearingloss.org [7 July 2019]Google Scholar
45Shendure, J, Balasubramanian, S, Church, GM, Gilbert, W, Rogers, J, Schloss, JA et al. DNA sequencing at 40: past, present and future. Nature 2017;550:345–53Google Scholar
46Shendure, J, Ji, H. Next-generation DNA sequencing. Nat Biotechnol 2008;26:1135–45Google Scholar
47Ranum, PT, Goodwin, AT, Yoshimura, H, Kolbe, DL, Walls, WD, Koh, J-Y et al. Insights into the biology of hearing and deafness revealed by single-cell RNA sequencing. Cell Rep 2019;26:3160–71.e3Google Scholar
48Ahmed, H, Shubina-Oleinik, O, Holt, JR. Emerging gene therapies for genetic hearing loss. J Assoc Res Otolaryngol 2017;18:649–70Google Scholar
49ClinicalTrials.gov. Safety, Tolerability and Efficacy for CGF166 in Patients with Unilateral or Bilateral Severe-to-profound Hearing Loss (Identifier NCT02132130). In: https://clinicaltrials.gov/ct2/show/NCT02132130 [7 July 2019]Google Scholar
50Cong, L, Ran, FA, Cox, D, Lin, S, Barretto, R, Habib, N et al. Multiplex genome engineering using CRISPR/Cas systems. Science 2013;339:819–23Google Scholar
51Hsu, PD, Lander, ES, Zhang, F. Development and applications of CRISPR-Cas9 for genome engineering. Cell 2014;157:1262–78Google Scholar
52Gao, X, Tao, Y, Lamas, V, Huang, M, Yeh, W-H, Pan, B et al. Treatment of autosomal dominant hearing loss by in vivo delivery of genome editing agents. Nature 2018;553:217–21Google Scholar
53Ren, Y, Sagers, JE, Landegger, LD, Bhatia, SN, Stankovic, KM. Tumor-penetrating delivery of siRNA against TNFα to human vestibular schwannomas. Sci Rep 2017;7:12922Google Scholar
54Isgrig, K, McDougald, DS, Zhu, J, Wang, HJ, Bennett, J, Chien, WW. AAV2.7m8 is a powerful viral vector for inner ear gene therapy. Nat Commun 2019;10:427Google Scholar
55Landegger, LD, Pan, B, Askew, C, Wassmer, SJ, Gluck, SD, Galvin, A et al. A synthetic AAV vector enables safe and efficient gene transfer to the mammalian inner ear. Nat Biotechnol 2017;35:280–4Google Scholar
56Tandon, V, Kang, WS, Robbins, TA, Spencer, AJ, Kim, ES, McKenna, MJ et al. Microfabricated reciprocating micropump for intracochlear drug delivery with integrated drug/fluid storage and electronically controlled dosing. Lab Chip 2016;16:829–46Google Scholar
57Mura, S, Nicolas, J, Couvreur, P. Stimuli-responsive nanocarriers for drug delivery. Nat Mater 2013;12:991–1003Google Scholar
58Nyberg, S, Abbott, NJ, Shi, X, Steyger, PS, Dabdoub, A. Delivery of therapeutics to the inner ear: the challenge of the blood-labyrinth barrier. Sci Transl Med 2019;11:eaao0935Google Scholar
59Clemens, E, van den Heuvel-Eibrink, MM, Mulder, RL, Kremer, LCM, Hudson, MM, Skinner, R et al. Recommendations for ototoxicity surveillance for childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCare Consortium. Lancet Oncol 2019;20:e29–41Google Scholar
60Brock, PR, Maibach, R, Childs, M, Rajput, K, Roebuck, D, Sullivan, MJ et al. Sodium thiosulfate for protection from cisplatin-induced hearing loss. N Engl J Med 2018;378:2376–85Google Scholar
61Muldoon, LL, Wu, YJ, Pagel, MA, Neuwelt, EA. N-acetylcysteine chemoprotection without decreased cisplatin antitumor efficacy in pediatric tumor models. J Neurooncol 2015;121:433–40Google Scholar
62World Health Organization. Critically Important Antimicrobials for Human Medicine. Geneva: WHO Document Production Services, 2011Google Scholar
63Van Boeckel, TP, Gandra, S, Ashok, A, Caudron, Q, Grenfell, BT, Levin, SA et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis 2014;14:742–50Google Scholar
64O'Sullivan, ME, Perez, A, Lin, R, Sajjadi, A, Ricci, AJ, Cheng, AG. Towards the prevention of aminoglycoside-related hearing loss. Front Cell Neurosci 2017;11:325Google Scholar
65Huth, ME, Han, K-H, Sotoudeh, K, Hsieh, Y-J, Effertz, T, Vu, AA et al. Designer aminoglycosides prevent cochlear hair cell loss and hearing loss. J Clin Invest 2015;125:583–92Google Scholar
66Song, J-J, Lee, BD, Lee, KH, Lee, JD, Park, YJ, Park, MK. Changes in antibiotic resistance in recurrent Pseudomonas aeruginosa infections of chronic suppurative otitis media. Ear Nose Throat J 2016;95:446–51Google Scholar
67Kealey, C, Creaven, CA, Murphy, CD, Brady, CB. New approaches to antibiotic discovery. Biotechnol Lett 2017;39:805–17Google Scholar
68Todd, DW, Philip, RC, Niihori, M, Ringle, RA, Coyle, KR, Zehri, SF et al. A fully automated high-throughput zebrafish behavioral ototoxicity assay. Zebrafish 2017;14:331–42Google Scholar
69Navalkele, BD, Revankar, S, Chandrasekar, P. Candida auris: a worrisome, globally emerging pathogen. Expert Rev Anti Infect Ther 2017;15:819–27Google Scholar
70Choi, HI, An, J, Hwang, JJ, Moon, S-Y, Son, JS. Otomastoiditis caused by Candida auris: case report and literature review. Mycoses 2017;60:488–92Google Scholar
71Tzounopoulos, T, Balaban, C, Zitelli, L, Palmer, C. Towards a mechanistic-driven precision medicine approach for tinnitus. J Assoc Res Otolaryngol 2019;20:115–32Google Scholar
72Ryan, D, Bauer, CA. Neuroscience of tinnitus. Neuroimaging Clin N Am 2016;26:187–96Google Scholar
73De Ridder, D, Vanneste, S, van der Loo, E, Plazier, M, Menovsky, T, van de Heyning, P. Burst stimulation of the auditory cortex: a new form of neurostimulation for noise-like tinnitus suppression. J Neurosurg 2010;112:1289–94Google Scholar
74Roberts, LE, Eggermont, JJ, Caspary, DM, Shore, SE, Melcher, JR, Kaltenbach, JA. Ringing ears: the neuroscience of tinnitus. J Neurosci 2010;30:14972–9Google Scholar
75Adamchic, I, Toth, T, Hauptmann, C, Walger, M, Langguth, B, Klingmann, I et al. Acute effects and after-effects of acoustic coordinated reset neuromodulation in patients with chronic subjective tinnitus. Neuroimage Clin 2017;15:541–58Google Scholar
76Shi, Y, Burchiel, KJ, Anderson, VC, Martin, WH. Deep brain stimulation effects in patients with tinnitus. Otolaryngol Head Neck Surg 2009;141:285–7Google Scholar
77Corwin, JT, Cotanche, DA. Regeneration of sensory hair cells after acoustic trauma. Science 1988;240:1772–4Google Scholar
78Atkinson, PJ, Huarcaya Najarro, E, Sayyid, ZN, Cheng, AG. Sensory hair cell development and regeneration: similarities and differences. Development 2015;142:1561–71Google Scholar
79Janesick, AS, Heller, S. Stem cells and the bird cochlea--where is everybody? Cold Spring Harb Perspect Med 2019;9:a033183Google Scholar
80Oshima, K, Grimm, CM, Corrales, CE, Senn, P, Martinez Monedero, R, Géléoc, GSG et al. Differential distribution of stem cells in the auditory and vestibular organs of the inner ear. J Assoc Res Otolaryngol 2007;8:18–31Google Scholar
81Roccio, M, Perny, M, Ealy, M, Widmer, HR, Heller, S, Senn, P. Molecular characterization and prospective isolation of human fetal cochlear hair cell progenitors. Nat Commun 2018;9:4027Google Scholar
82Atkinson, PJ, Kim, GS, Cheng, AG. Direct cellular reprogramming and inner ear regeneration. Expert Opin Biol Ther 2018. Epub 2018 Dec 25Google Scholar
83Kujawa, SG, Liberman, MC. Adding insult to injury: cochlear nerve degeneration after ‘temporary’ noise-induced hearing loss. J Neurosci 2009;29:14077–85Google Scholar
84Liberman, MC, Kujawa, SG. Cochlear synaptopathy in acquired sensorineural hearing loss: manifestations and mechanisms. Hear Res 2017;349:138–47Google Scholar
85Simoni, E, Orsini, G, Chicca, M, Bettini, S, Franceschini, V, Martini, A et al. Regenerative medicine in hearing recovery. Cytotherapy 2017;19:909–15Google Scholar
86Zhang, T, Mustiere, F, Micheyl, C. Intelligent hearing aids: the next revolution. In: 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). Orlando: IEEE. 2016;72–6Google Scholar
87Reed, NS, Betz, J, Kendig, N, Korczak, M, Lin, FR. Personal sound amplification products vs a conventional hearing aid for speech understanding in noise. JAMA 2017;318:89–90Google Scholar
88Lin, FR, Yaffe, K, Xia, J, Xue, Q-L, Harris, TB, Purchase-Helzner, E et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013;173:293–9Google Scholar
89Loughrey, DG, Kelly, ME, Kelley, GA, Brennan, S, Lawlor, BA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2018;144:115–26Google Scholar
90Sperling, NM, Yerdon, SE, D'Aprile, M. Extended-wear hearing technology: the nonimplantables. Otolaryngol Clin North Am 2019;52:221–30Google Scholar
91Chang, CYJ. Ossicle coupling active implantable auditory devices: magnetic driven system. Otolaryngol Clin North Am 2019;52:273–83Google Scholar
92Ghossaini, SN, Roehm, PC. Osseointegrated auditory devices: bone-anchored hearing aid and PONTO. Otolaryngol Clin North Am 2019;52:243–51Google Scholar
93den Besten, CA, Monksfield, P, Bosman, A, Skarzynski, PH, Green, K, Runge, C et al. Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: six-month results from a multicentre study. Clin Otolaryngol 2019;44:144–57Google Scholar
94Starkey. Livio AI. In: https://www.starkey.com/hearing-aids/technologies/livio-artificial-intelligence-hearing-aids [7 July 2019]Google Scholar
95Li, X, Dunn, J, Salins, D, Zhou, G, Zhou, W, Schüssler-Fiorenza Rose, SM et al. Digital health: tracking physiomes and activity using wearable biosensors reveals useful health-related information. PLoS Biol 2017;15:e2001402Google Scholar
96Maxmen, A. Google spin-off deploys wearable electronics for huge health study. Nature 2017;547:13–14Google Scholar
97Jackler, RK. The impending end to the stigma of wearing ear devices and its revolutionary implications. Otol Neurotol 2006;27:299–300Google Scholar
98Perez Fornos, A, Guinand, N, van de Berg, R, Stokroos, R, Micera, S, Kingma, H et al. Artificial balance: restoration of the vestibulo-ocular reflex in humans with a prototype vestibular neuroprosthesis. Front Neurol 2014;5:66Google Scholar
99Perez Fornos, A, Cavuscens, S, Ranieri, M, van de Berg, R, Stokroos, R, Kingma, H et al. The vestibular implant: a probe in orbit around the human balance system. J Vestib Res 2017;27:51–61Google Scholar
100Phillips, JO, Ling, L, Nie, K, Jameyson, E, Phillips, CM, Nowack, AL et al. Vestibular implantation and longitudinal electrical stimulation of the semicircular canal afferents in human subjects. J Neurophysiol 2015;113:3866–92Google Scholar
101Lewis, RF. Vestibular implants studied in animal models: clinical and scientific implications. J Neurophysiol 2016;116:2777–88Google Scholar
102Chow, M, Gimmon, Y, Schoo, D, Trevino, C, Boutros, P, Rahman, M et al. First-in-human clinical trial of the MVI™ multichannel vestibular implant: continuous restoration of the human vestibulo-ocular reflex. In: Proceedings of the Association for Research in Otolaryngology 41st Annual MidWinter Meeting. San Diego: Association for Research in Otolaryngology, 2018Google Scholar
103Della Santina, CC. Perspective of a clinician-scientist: the labyrinth devices MVI™ vestibular implant – a case study on navigating the path from basic science to first-in-human trial. In: Proceedings of the Association for Research in Otolaryngology 41st Annual MidWinter Meeting. San Diego: Association for Research in Otolaryngology, 2018Google Scholar
104Schoo, D, Bowditch, S, Marsiglia, D, Boutros, P, Chow, M, Gimmon, Y et al. Long-term audiometric results from the first 3 subjects of the MVI™ multichannel vestibular implant early feasibility study. In: Proceedings of the Association for Research in Otolaryngology 41st Annual MidWinter Meeting. San Diego: Association for Research in Otolaryngology, 2018Google Scholar
105Ward, BK, Otero-Millan, J, Jareonsettasin, P, Schubert, MC, Roberts, DC, Zee, DS. Magnetic vestibular stimulation (MVS) as a technique for understanding the normal and diseased labyrinth. Front Neurol 2017;8:122Google Scholar
106Agrawal, Y, Carey, JP, Della Santina, CC, Schubert, MC, Minor, LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med 2009;169:938–44Google Scholar
107Agrawal, Y, Ward, BK, Minor, LB. Vestibular dysfunction: prevalence, impact and need for targeted treatment. J Vestib Res 2013;23:113–17Google Scholar
108Shojania, KG, Dixon-Woods, M. Estimating deaths due to medical error: the ongoing controversy and why it matters. BMJ Qual Saf 2017;26:423–8Google Scholar
109Javia, L, Sardesai, MG. Physical models and virtual reality simulators in otolaryngology. Otolaryngol Clin North Am 2017;50:875–91Google Scholar
110Barber, SR, Kozin, ED, Dedmon, M, Lin, BM, Lee, K, Sinha, S et al. 3D-printed pediatric endoscopic ear surgery simulator for surgical training. Int J Pediatr Otorhinolaryngol 2016;90:113–18Google Scholar
111Locketz, GD, Lui, JT, Chan, S, Salisbury, K, Dort, JC, Youngblood, P et al. Anatomy-specific virtual reality simulation in temporal bone dissection: perceived utility and impact on surgeon confidence. Otolaryngol Head Neck Surg 2017;156:1142–9Google Scholar
112Lui, JT, Hoy, MY. Evaluating the effect of virtual reality temporal bone simulation on mastoidectomy performance: a meta-analysis. Otolaryngol Head Neck Surg 2017;156:1018–24Google Scholar
113Won, T-B, Hwang, P, Lim, JH, Cho, S-W, Paek, SH, Losorelli, S et al. Early experience with a patient-specific virtual surgical simulation for rehearsal of endoscopic skull-base surgery. Int Forum Allergy Rhinol 2018;8:54–63Google Scholar
114Chan, S, Li, P, Locketz, G, Salisbury, K, Blevins, NH. High-fidelity haptic and visual rendering for patient-specific simulation of temporal bone surgery. Comput Assist Surg (Abingdon) 2016;21:85–101Google Scholar
115Scott, DJ, Pugh, CM, Ritter, EM, Jacobs, LM, Pellegrini, CA, Sachdeva, AK. New directions in simulation-based surgical education and training: validation and transfer of surgical skills, use of nonsurgeons as faculty, use of simulation to screen and select surgery residents, and long-term follow-up of learners. Surgery 2011;149:735–44Google Scholar
116Hafford, ML, Van Sickle, KR, Willis, RE, Wilson, TD, Gugliuzza, K, Brown, KM et al. Ensuring competency: are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel? Surg Endosc 2013;27:118–26Google Scholar
117Tool Detection and Operative Skill Assessment in Surgical Videos Using Region-Based Convolutional Neural Networks. In: http://arxiv.org/abs/1802.08774 [7 July 2019]Google Scholar