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Endoscopic ear surgery provides superior anatomical visualization but inferior advanced skill training compared to microscopyEndoscopic Ear Surgery Offers Better Visuals for Student Training

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Key Takeaway
Integrate both EES and MES sequentially in curricula to balance anatomical orientation with advanced skill refinement.

This systematic review synthesized 8 studies involving 287 participants to evaluate the educational value of endoscopic ear surgery (EES) compared to microscopic ear surgery (MES) across cognitive, psychomotor, and affective domains. The review focused on medical students, residents, and fellows in otolaryngology training programs.

Findings indicate that EES is consistently rated higher in the affective domain, specifically regarding optical quality and anatomical visualization. In the cognitive domain, no significant difference was found between the two modalities, though EES was noted to provide a shared perspective beneficial for early orientation. Conversely, in the psychomotor domain, MES was frequently preferred by senior trainees for developing bimanual dexterity and depth perception.

Limitations of the evidence include significant study heterogeneity and a reliance on subjective measures. The authors note that while EES excels in early-phase anatomical orientation, MES remains crucial for advanced technical skill refinement. Clinical application suggests that otolaryngology curricula should integrate both modalities sequentially to optimize surgical competency. The overall certainty of these findings is low to moderate.

This review looked at how medical students and residents learn to perform ear surgery. Researchers compared two methods: endoscopic ear surgery (EES) and microscopic ear surgery (MES). The study included 287 participants across eight different training settings, including simulations and live surgeries.

Findings show that students preferred the endoscopic method because it provided better visual quality and helped them understand anatomy more easily during the early stages of training. However, the study found no significant difference in how much anatomical knowledge students gained from either method.

For advanced technical skills, such as hand coordination and depth perception, senior trainees often preferred the traditional microscope. Because the evidence is based on a review of various studies with some subjective measures, the results are not definitive. Experts suggest that training programs should use both methods in a specific order to help students master both the visual orientation and the advanced physical skills needed for surgery.

What this means for you:
Endoscopic tools help students learn anatomy, while microscopes are still useful for mastering advanced skills.

Common questions

What are the benefits of using endoscopic tools for students?

Endoscopic ear surgery (EES) was consistently rated higher for its optical quality and anatomical visualization. It provides a shared perspective that can be helpful for students during the early stages of their training to help them orient themselves with the anatomy.

Is endoscopic surgery better for learning anatomy than microscopes?

The study found no significant difference in anatomical knowledge acquisition between the two methods. While endoscopic tools offer better visuals, both methods were found to be effective for teaching the basic anatomy of the ear to students.

When is a microscope still preferred in training?

Microscopic ear surgery (MES) was frequently preferred by senior trainees for psychomotor skills. This includes developing bimanual dexterity and depth perception, which are necessary for advanced technical skills in the operating room.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
ObjectiveTo systematically review the educational value of endoscopic ear surgery (EES) compared to microscopic ear surgery (MES) in otolaryngology training programs.Data sourcesPubMed, Web of Science, Cochrane Library, and Scopus (up to October 2025).Review methodsA systematic review was conducted following PRISMA guidelines. Studies comparing EES and MES in educational settings (cadaveric, live surgery, or simulation) involving medical students, residents, or fellows were included. Outcomes were categorized into cognitive (anatomical knowledge), psychomotor (technical skills), and affective (perceived educational value) domains. Risk of bias was assessed using RoB 2, ROBINS-I, and JBI tools, and the certainty of evidence was evaluated using the GRADE approach.ResultsEight studies (n = 287 participants) met the inclusion criteria. In the affective domain, EES was consistently rated higher for perceived educational value, optical quality, and anatomical visualization, particularly by junior trainees. In the cognitive domain, objective assessments of anatomical knowledge acquisition showed no significant difference between modalities, though EES provided a shared perspective beneficial for early orientation. In the psychomotor domain, MES was frequently preferred by senior trainees for developing bimanual dexterity and depth perception. The overall certainty of evidence was low to moderate due to study heterogeneity and reliance on subjective measures.ConclusionEES and MES offer complementary educational benefits. EES excels in early-phase anatomical orientation and shared visualization, while MES remains crucial for advanced technical skill refinement. Otolaryngology curricula should integrate both modalities sequentially to optimize surgical competency.
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