European Archives of Oto Rhino Laryngology 2021-08-01

Correction to: Epidemiological, otolaryngological, olfactory and gustatory outcomes according to the severity of COVID-19: a study of 2579 patients

JR Lechien,CM Chiesa-Estomba,LA Vaira,G De Riu,G Cammaroto,Y Chekkoury-Idrissi,M Circiu,L Distinguin,F Journe,C de Terwangne,S Machayekhi,MR Barillari,C Calvo-Henriquez,S Hans,S Saussez

Publication date 01-08-2021


In the original publication of the article, one of the co-author’s name was published incorrectly as “Liugi A. Varia”. The correct name should read as “Luigi A. Vaira”.

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Cerebrospinal fluid gusher in incomplete partition type I anomaly

L Sennaroglu

Publication date 01-08-2021


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Authors’ reply to the published comment regarding our article: Application of the new SMS system of cochleovestibular anomalies: our experience with nine cases of type III anomaly

M Grover,A Kanodia,G Gupta,C Preetam,S Samdani

Publication date 01-08-2021


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Correction to: Prognostic outcomes of treatment naïve oral tongue squamous cell carcinoma (OTSCC): a comprehensive analysis of 14\xa0years

M Faisal,R Dhanani,S Ullah,MA Bakar,N Irfan,KI Malik,A Loya,BM Erovic,R Hussain,A Jamshed

Publication date 01-08-2021


The original article can be found online.

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The displacement technique: a simple method for clearing maxillary sinus stubborn mucus

S Samargandy,DJ Lee,JM Lee

Publication date 01-08-2021


Background Clearing thick secretions from the hidden crevices of the maxillary sinus can be challenging and can increase operative time during endoscopic sinus surgery. Methods We demonstrate the Displacement Technique as a user-friendly technique to address thick secretions within the maxillary sinus barring no orbital floor dehiscence. First, a wide maxillary antrostomy is performed. Then, a surgical pledget is placed in the maxillary sinus to displace the inspissated content into the nasal cavity using a curved suction. This process is repeated as necessary. Conclusion The displacement technique is a simple and inexpensive method for addressing stubborn secretions.

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Effect of head position on cochlear implant MRI artifact

N Ay,HB Gehl,H Sudhoff,I Todt

Publication date 01-08-2021


Purpose A new generation of cochlear implant (CI) magnets and specific surgical techniques (e.g., implant positioning) has changed the relationship between a CI and magnet resonance imaging (MRI). MRI allows a pain free in vivo evaluation of the inner ear fluid state and internal auditory canal after the insertion of an electrode. The aim of this study is to evaluate how the patient’s head position in the MRI scanner influences the CI magnet-related artefact. Methods We performed in vivo measurement of MRI artefacts at 3 T with a CI system containing a bipolar diametrical magnet. The implant magnet was positioned with a head bandage at different positions from the nasion and external auditory canal in three volunteers. We used a turbo spin echo (TSE) T2w sequence on the axial and coronal planes and observed three positions: (1) regular position, (2) chin to chest (anteflexion), and (3) hyperextension (retroflexion). Results By comparing the positions, anteflexion of the cervical spine in a chin-to-chest position allowed us to place the artefact in a more apical position from the IAC in the coronal plane. The hyperextension of the cervical spine position shifts the artefact father towards the cochlea’s direction. Conclusion The head’s position can influence the location of MRI artefacts. In cases where the artefact diminished the IAC or cochlea, anteflexion of the cervical spine in the chin-to-chest position of the head in the MRI scanner should be attempted to allow a visualization of the IAC.

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Black fungus and COVID-19: role of otorhinolaryngologists and audiologists

AF Raza,DR Paudel,P Prabhu

Publication date 01-08-2021


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Brain solutions for hearing problems during the COVID-19 pandemic and the misery of wearing a mask

N Derakhshan,S Yaghmaei

Publication date 01-08-2021


Background In COVID-19 pandemics days, wearing facial mask in public places has become obligatory to prevent the virus spread. In addition to its valuable protection, wearing facial mask can affect verbal communication in an adverse fashion and makes mutual understanding difficult. This happens because the mask eliminates the positive effect of the lip-reading phenomenon in direct communications. The mirror neuron system is responsible for automatic imitation, associative sequence learning, and motor mimicry. This system is a strong candidate justifying an unexpected action described in this article. Purpose Taking the facial mask off, to help the listener understanding better is a normal reaction. However, unexpectedly, one does the same as the listener when he/she is unable to comprehend the speaker. Herein, we suggest a hypothesis proposing the basic role of Mirror neuron system in this action. Most of the research on these cells have been conducted on monkeys, where the researchers observed that, these neuron discharge pulses both when a monkey performs an action and when it observes another monkey or a person committing the similar action. Conclusion The driving mechanism of an unanticipated action of taking off mask while listening to a speaker is emphasized in this paper. Herein, we try to clarify how we came up with the idea that mirror neuron system drives a surprising action observed in COVID-19 pandemics days. As a result, we suggest possible clinical studies to verify our hypothesis.

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Teaching middle ear anatomy using a novel three-dimensional papercraft model

J Guy,J Muzaffar,C Coulson

Publication date 01-08-2021


Background The middle ear is a complex anatomical space which is difficult to interpret from two-dimensional imagery. Appropriate surgical knowledge of the area is required to operate, yet current anatomical teaching methods are costly and hard to access for the trainee. Methods A papercraft 3D design involving anatomical elements added separately to a model was designed, and then peer-validated by medical students and junior doctors. Preliminary quantitative assessment was performed using an anatomical labelling questionnaire, with six students given a lecture to act as a control. Qualitative feedback was also gathered. Results 18 participants were recruited for the study. A total of 12 models were constructed by 6 medical students and 6 junior doctors. 6 medical students received a lecture only. Qualitative feedback was positive and suggested the model improved knowledge and was useful, yet timing and complexity were issues. Students scored, on average, 37% higher after completing the model, with junior doctors also improving anatomical knowledge, though these differences were not significant (p > 0.05). Conclusions In this initial investigation, the model was shown to be an engaging way to learn anatomy, with the tactile and active nature of the process cited as benefits. Construction of the model improved anatomical knowledge to a greater extent than a classical lecture in this study, though this difference was not significant. Further design iterations are required to improve practical utility in the teaching environment, as well as a larger study.

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COVID-19 infection rate among tertiary referral center otorhinolaryngology healthcare workers

KMB Rasmussen,PA Andersen,HI Channir,K Aanæs,JD Knudsen,NS Kirkeby,M Klokker,C von Buchwald,P Cayé-Thomasen,RG Jensen

Publication date 01-08-2021


Importance Otorhinolaryngology is considered one of the medical specialties with a high risk for exposure to corona disease 2019 (COVID-19). Uncontrolled transmission in a hospital department poses a risk to both healthcare workers (HCWs) and patients. Objective To monitor SARS-CoV-2 incidence, transmission, and antibody development among HCWs to identify high risk procedures, pathways, and work areas within the department. Methods Prospective cohort study of HCWs using repetitive oro- and nasopharygeal swab samples, antibody tests, and self-reported symptoms questionnaires at a tertiary referral center in Copenhagen, Denmark. Results 347/361 (96%) HCWs participated. Seven (1.9%) were positive on swab tests and none had symptoms. Fifteen (4.2%) developed antibodies. Only one case of potential transmission between HCWs was identified. Infection rates were low and no procedures or areas within the department were identified as exposing HCWs to a higher risk. Conclusions and relevance Adherence to the surveillance program was high. The low incidence among HCW during the first wave of the COVID-19 pandemic may reflect local transmission and infection control precautions, as well as a low infectious burden in the Danish society.

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Intraoral ultrasonography in the assessment of DOI in oral cavity squamous cell carcinoma: a comparison with magnetic resonance and histopathology

M Filauro,F Missale,F Marchi,A Iandelli,ALC Carobbio,F Mazzola,G Parrinello,E Barabino,G Cittadini,D Farina,C Piazza,G Peretti

Publication date 01-08-2021


Objective The first-line therapeutic approach for oral cavity squamous cell carcinoma (OCSCC) is complete surgical resection. Preoperative assessment of depth of invasion (cDOI) is crucial to plan the surgery. Magnetic resonance (MR) and intraoral ultrasonography (IOUS) have been shown to be useful tools for assessment of DOI. The present analysis investigates the accuracy of MR and IOUS in evaluating DOI in OCSCC compared to histological evaluation (pDOI). Materials and methods Forty-nine previously untreated patients with cT1-T3 OCSCC were reviewed. Nine patients were staged with MR alone, 10 with IOUS alone, and 30 with both MR and IOUS. Results Mean difference between cDOIMR and pDOI values of 0.2 mm (95% CI − 1.0–1.3 mm) and between cDOIIOUS and pDOI of 0.3 mm (95% CI − 1.0–1.6 mm). Spearman R between cDOIMR and pDOI was R = 0.83 and between cDOIIOUS and pDOI was R = 0.76. Both radiological techniques showed high performance for the correct identification, with the optimum cut-off of 5 mm, of patients with a pDOI ≥ 4 mm and amenable to a neck dissection, with an AUC of 0.92 and 0.82 for MR and IOUS, respectively. Conclusion Both examinations were valid approaches for preoperative determination of DOI in OCSCC, although with different cost-effectiveness profiles and indications.

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Oncologic results and quality of life in patients with T3 glottic cancer after transoral laser microsurgery

PJ Chien,LT Hung,LW Wang,MH Yang,PY Chu

Publication date 01-08-2021


Purpose CO2 transoral laser microsurgery (CO2 TOLMS) is an alternative approach to non-surgical organ preservation in selected T3 glottic squamous cell carcinoma (SCC). This study aimed to assess the oncologic results and quality of life (QOL) of patients with T3 glottic SCC after CO2 TOLMS. Methods Of the 44 patients who underwent CO2 TOLMS, 38 underwent QOL evaluations. QOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and head and neck module, Voice Handicap Index-30, and M. D. Anderson Dysphagia Inventory at least 6 months postoperatively. Results The patients were predominantly male (98%), with a median age of 61 years. Cordectomy type included 1 type III, 4 type IV, 31 type V, and 8 type VI according to European Laryngological Society classification. Two patients (5%) had cervical lymph node metastasis and 21 patients (48%) underwent postoperative radiotherapy. With a mean follow-up of 65 months for all patients, 10 (23%) had tumor recurrence (9 local, 1 distant). After salvage surgery, four patients lived without disease, and the larynx was preserved in two. The 5-year local control and overall and disease-specific survival rates were 78%, 75%, and 84%, respectively. The overall laryngeal preservation rate was 82% (36/44). Most patients had satisfactory QOL. Conclusions In selected T3 glottic SCC cases, CO2 TOLMS can achieve favorable oncologic results and a satisfactory QOL.

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Comparison of core-needle biopsy and repeat fine-needle aspiration for thyroid nodules with inconclusive initial cytology

SM Jung,HR Koo,KS Jang,MS Chung,CM Song,YB Ji,JS Park,K Tae

Publication date 01-08-2021


Purpose We aimed to compare the efficacy of ultrasound-guided core-needle biopsy (CNB) with repeat fine-needle aspiration (rFNA) cytology in thyroid nodules with inconclusive results in initial fine-needle aspiration cytology. Methods We studied 402 patients who required a repeat biopsy of thyroid nodules using ultrasound-guided CNB (n = 192) or rFNA (n = 210) because of inconclusive results in initial FNA, corresponding to categories I, III, and IV of the Bethesda System for Reporting Thyroid Cytopathology. If repeat biopsy results were benign (category II), suspicious malignancy (category V), or malignancy (category VI), they were defined as “diagnostic results”. The diagnostic yield and performances of repeat biopsy were analyzed and compared between the rFNA and CNB groups. Results The diagnostic results were obtained significantly higher in the CNB group than in the rFNA group (72.4% vs. 52.4%; P < 0.001). In the subgroup analysis, the diagnostic results were significantly higher in the CNB group than in the rFNA group for patients of categories I and III (P < 0.001 in both) in initial FNA. However, in patients with category IV nodules, there were no significant differences in diagnostic results between the two groups (P = 0.46). Conclusion Compared to rFNA, ultrasound-guided CNB is useful and effective as a repeat biopsy option for thyroid nodules with non-diagnostic results (category I) and atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) (category III) in initial FNA.

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Is ossicular chain fixation predictable for tympanosclerosis on preoperative temporal bone computed tomography?

S Yildiz,AÖ Balık,S Zer Toros

Publication date 01-08-2021


Purpose To report the predictability of ossicular chain (OC) fixation on preoperative temporal bone computed tomography (TBCT) in chronic otitis media (COM) with tympanosclerosis (TS). Methods Fifty-six patients who had surgery for COM in our ear, nose and throat clinic between 2015 and 2017 were included in this retrospective case–control study. The patients were equally divided into two groups as those with TS and without TS. The complaint of preoperative otorrhea, values of incudostapedial joint (ISJ) angulation on preoperative TBCT scans, postoperative long-term hearing results, and postoperative complications were compared between the two groups. Results There was a statistically significant difference between the ISJ angulations of the operated and healthy sides in the COM group with TS (102.27 ± 7.92 and 91.90 ± 5.59 degrees, respectively, p < 0.001). However, no statistically significant difference was observed between the ISJ angulation of the operated and healthy sides in the COM group without TS (95.04 ± 4.86 and 94.35 ± 4.57 degrees, respectively, p > 0.05). In addition, when the ISJ angulations of the operated sides of the two groups were compared, it was statistically significantly higher for the TS group compared to the non-TS group (102.27 ± 7.92 and 95.04 ± 4.86 degrees, respectively, p < 0.001). Conclusion Increased ISJ angulation may indicate OC fixation. COM cases with TS can be predicted by the measurement of ISJ angulation on preoperative TBCT.

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Can hearing amplification improve presbyvestibulopathy and/or the risk-to-fall ?

A Ernst,D Basta,P Mittmann,RO Seidl

Publication date 01-08-2021


Purpose The decline of sensory systems during aging has been widely investigated and several papers have correlated the visual, hearing and vestibular systems and the consequences of their functional degeneration. Hearing loss and presbyvestibulopathy have been found to be positively correlated as is with the risk-to-fall. Material and methods The present study was therefore designed as systematic review (due to PRISMA criteria) which should correlate hearing amplification by hearing aids and/or cochlear implants with balance outcome. However, the literature review (Cochrane, Pub Med) revealed ten paper (prospective, controlled trials and acute trials) with heterogenous patient popiulations and non-uniform outcome measures (i.e., gait analysis, questionnaires, postural stabilometry) so that no quantitative, statistical analysis could be performed. Results The qualitative analysis oft he identified studies showed that hearing amplification in the elderly improves spatio-temporal orientation (particularly with cochlear implants) and that the process of utilizing auditory information for balance control takes some time (i.e., the neuroplasticity-based, learning processes), usually some months in cochlear implantees. Discussion Hearing and balance function degenerate independently from each other and large interindividual differences require a separate neurotological examination of each patient. However, hearing amplification is most helpful to improve postural stability, particularly in the elderly. Future research should focus on controlled, prospective clinical trials where a standardized test battery covering the audiological and neurotological profile of each elderly patient pre/post prescription of hearing aids and/or cochlear implantation should be followed up (for at least 1 year) so that also the balance improvements and the risk-to-fall can be reliably assessed (e.g., by mobile posturography and standardized questionnaires, e.g., the DHI).

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Head and neck adult-type soft tissues sarcomas: survival analysis and comparison between the last two editions of the TNM staging system

L Giannini,L Bresciani,A Paderno,F Incandela,M Fiore,A Gronchi,C Piazza

Publication date 01-08-2021


Purpose Head and neck soft tissues sarcomas (HNSTS) are a heterogeneous group of rare tumours. The 8th edition of the TNM staging system (8TNM) considered these lesions separately for the first time. The aim of this study is to assess its effectiveness and identify the most significant prognostic factors for HNSTS. Methods A retrospective survival analysis on 101 HNSTS operated between 1995 and 2015 at the National Cancer Institute of Milan was carried out. The variables considered were pathological stage (according to both the 7TNM and 8TNM), site, histotype, depth, grading, surgical radicality, (neo)adjuvant radiotherapy and/or chemotherapy. Results According to the 7TNM, the T category distribution was 35 T1a, 23 T1b, 11 T2a, and 32 T2b. Applying the 8TNM, the distribution changed to 19 T1, 18 T2, 35 T3, and 29 T4. Five-year overall and disease-specific survivals were 74.3 and 76.2%, respectively. Univariate analysis demonstrated an increased hazard ratio (HR) for deep lesions invading adjacent structures, high-grade, surgery with close/microscopically positive margins, and chemotherapy. Multivariate analysis confirmed an increased HR for deep location and size > 5 cm, G2–G3 tumours, and marginal surgery. No significant difference was found among T categories of the 8TNM. Conclusion The present study underlines the negative prognostic impact of depth, size > 5 cm, high grade, and marginal treatment for HNSTS. Our results did not allow to validate the 8TNM staging system since, apparently, it was not associated with meaningful prognostic stratification. Further studies with wider multicentric cohorts should, however, be performed to obtain more powerful statistical data.

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Contribution of noise reduction pre-processing and microphone directionality strategies in the speech recognition in noise in adult cochlear implant users

MVS Goffi-Gomez,L Muniz,G Wiemes,LC Onuki,L Calonga,FJ Osterne,MI Kós,FF Caldas,C Cardoso,B Cagnacci

Publication date 01-08-2021


Purpose Refinement currently offered in new sound processors may improve noise listening capability reducing constant background noise and enhancing listening in challenging signal-to-noise conditions. This study aimed to identify whether the new version of speech processor preprocessing strategy contributes to speech recognition in background noise compared to the previous generation processor. Methods This was a multicentric prospective cross-sectional study. Post-lingually deaf adult patients, with at least 1 year of device use and speech recognition scores above 60% on HINT sentences in quiet were invited.
Speech recognition performance in quiet and in noise with sound processors with previous and recent technologies was assessed under four conditions with speech coming from the front: (a) quiet (b) fixed noise coming from the front, (c) fixed noise coming from the back, and (d) adaptive noise ratios with noise coming from the front. Results Forty-seven cochlear implant users were included. No significant difference was found in quiet condition. Performance with the new processor was statistically better than the previous sound processor in all three noisy conditions (p < 0.05). With fixed noise coming from the back condition, speech recognition was 62.9% with the previous technology and 73.5% on the new one (p < 0.05). The mean speech recognition in noise was also statistically higher, with 5.8 dB and 7.1 dB for the newer and older technologies (p < 0.05), respectively. Conclusion New technology has shown to provide benefits regarding speech recognition in noise. In addition, the new background noise reduction technology, has shown to be effective and improves speech recognition in situations of more intense noise coming from behind.

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Efficacy and safety of oral corticosteroids and olfactory training in the management of COVID-19-related loss of smell

SD Le Bon,D Konopnicki,N Pisarski,L Prunier,JR Lechien,M Horoi

Publication date 01-08-2021


Purpose As the COVID-19 pandemic continues, an increasing number of patients are afflicted by olfactory loss, a now well-recognized symptom of the disease. Though many patients seem to recover their sense of smell after a few weeks, a certain proportion of them seem to develop long-lasting olfactory disorder. Yet, as of October 2020, there is no recommended standardized treatment to reduce the risk of developing long-term olfactory disorder. In this pilot study, we investigated the efficacy and the safety of oral corticosteroids and olfactory training as a treatment for patients with persistent olfactory dysfunction as a result of COVID-19. Methods Non-hospitalized patients with a sudden loss of smell and a confirmed COVID-19 diagnosis were recruited by hospital call from February to April 2020. These participants were submitted to an extensive psychophysical testing in order to identify those with persistent dysosmia. Dysosmic patients were then treated either by a 10-day course of oral corticosteroids combined with olfactory training, or by olfactory training alone. All participants were subject to a second olfactory test after a mean of 10 weeks. Results 72 subjects with documented COVID-19 infection performed the initial olfactory test, on average 5 weeks after losing their sense of smell. Amongst them, 27 (37.5%) patients showed persistent dysosmia and were all included in this study. Nine participants received oral corticosteroids and performed olfactory training (OCS + OT), while 18 performed olfactory training (OT) only. Only participants in the OCS + OT group had significantly improved their olfactory score and did so above the minimal clinically important difference for subjective improvement of smell (p = 0.007). Three of the participants who received oral corticosteroids reported minimal and transient side effects. Conclusion This pilot study may suggest the combination of a short course of oral corticosteroids and olfactory training is safe and may be beneficial in helping patients with enduring dysosmia recover from olfactory loss due to COVID-19. There is a crucial need for further investigation with larger cohorts to corroborate these findings.

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Does inferior turbinate outfracture provide additional benefit when combined with inferior turbinate radiofrequency ablation?

SE Karakurt,MA Çetin,E Apaydın,A İkincioğulları,S Ensari,HH Dere

Publication date 01-08-2021


Purpose To evaluate, both subjectively and objectively, whether turbinate outfracture provides any additional benefit in the treatment of inferior turbinate hypertrophy when combined with radiofrequency ablation. Methods The study was conducted on 58 patients diagnosed with inferior turbinate hypertrophy. The patients were randomly divided into two groups according to the treatment they receive. Group A consisted of patients undergoing radiofrequency ablation and Group B included patients undergoing turbinate outfracture in combination with radiofrequency ablation. For the purposes of objective evaluation, all patients underwent acoustic rhinometry and anterior rhinomanometry preoperatively and at 6 months postoperatively. In addition, for subjective evaluation, the patients completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Postoperative changes in objective and subjective parameters in both groups versus the preoperative period and their differences were compared statistically. Results In Group A, mean postoperative minimal cross-sectional area (MCA) and nasal volume (NV) values and NOSE scores were significantly greater compared to those obtained in the preoperative period. Similarly, Group B showed significantly greater mean postoperative MCA, NV and NOSE score values compared to the preoperative period. In Group A and B, mean postoperative total nasal resistance (TNR) value was significantly lower in comparison to the preoperative period. The differences in mean preoperative and postoperative MCA, NV, TNR and NOSE scores were significantly greater in Group B versus Group A. Conclusion The addition of turbinate outfracture to inferior turbinate radiofrequency ablation treatment provides both objective and subjective benefits in the resolution of nasal obstruction.

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Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study

T Timonen,M Iso-Mustajärvi,P Linder,A Lehtimäki,H Löppönen,AP Elomaa,A Dietz

Publication date 01-08-2021


Purpose Consumer-grade virtual reality (VR) has recently enabled various medical applications, but more evidence supporting their validity is needed. We investigated the accuracy of simulated surgical planning in a VR environment (VR) with temporal bones and compared it to conventional cross-sectional image viewing in picture archiving and communication system (PACS) interface. Methods Five experienced otologic surgeons measured significant anatomic structures and fiducials on five fresh-frozen cadaveric temporal bones in VR and cross-sectional viewing. Primary image data were acquired by computed tomography. In total, 275 anatomical landmark measurements and 250 measurements of the distance between fiducials were obtained with both methods. Distance measurements between the fiducials were confirmed by physical measurement obtained by Vernier caliper. The experts evaluated the subjective validity of both methods on a 5-point Likert scale qualitative survey. Results A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916). Two-tailed paired t-test and Bland–Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% (p = 0.396) and 0.472 mm (p = 0.065) for anatomical and fiducial measurements, respectively. Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing. The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p < 0.001). Conclusion Our study supports good accuracy and reliability of VR environment for simulated surgical planning in temporal bones compared to conventional cross-sectional visualization.

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