The Ear, Nose and Throat Essential Skills Trainer: A Technical Note

The Ear, Nose and Throat Essential Skills Trainer: A Technical Note | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 3 March 2025 V1 Latest version Share on The Ear, Nose and Throat Essential Skills Trainer: A Technical Note Authors : Abdul Rafay 0009-0002-1358-0174 [email protected] and Issa Beegun Authors Info & Affiliations https://doi.org/10.22541/au.174099104.44271234/v1 285 views 99 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction Ensuring adequate training for doctors managing otolaryngology emergencies remains a challenge. Simulation-based training has emerged as an effective method to improve procedural competency. This study describes a low-cost, reusable ENT essential skills trainer designed to facilitate the practice of fundamental otolaryngology procedures. Materials and Methods A homemade simulator was constructed using a Styrofoam head, plastic tubing, and readily available materials. It incorporates models for nasal packing, otology skills (microsuction, myringotomy), flexible nasolaryngoscopy, and tracheal stoma care. Anatomical realism was enhanced by adding colour and pathological features. Results The trainer has been implemented in ENT induction programmes, demonstrating a significant reduction in trainee anxiety and an increase in procedural confidence. A comparative study showed superior knowledge retention in junior doctors taught using this model compared to traditional lecture-based teaching. Medical student workshops incorporating the trainer resulted in an increased interest in ENT as a career. The model has been further adapted for emergency airway training and quinsy drainage simulation. Discussion and Conclusion This cost-effective, reusable skills trainer provides an accessible method for improving competency in key otolaryngology procedures. Wider implementation could enhance procedural training, reduce anxiety in trainees, and improve clinical outcomes. Further studies should evaluate long-term skill retention and formal integration into structured training curricula. The Ear, Nose and Throat Essential Skills Trainer: A Technical Note Key points • A low-cost, reusable, and highly adaptable homemade model designed to facilitate the practice of essential otolaryngology skills, including nasal packing, microsuction, myringotomy, flexible nasolaryngoscopy, and tracheal stoma care. • Constructed using inexpensive, readily available materials, the trainer is portable and durable, making it a practical solution for widespread training in ENT procedures. • Simulation-based training using this model has been shown to significantly reduce trainee anxiety, improve procedural confidence, and enhance knowledge retention compared to traditional lecture-based teaching. • Interactive workshops utilising the trainer have effectively increased medical student interest in ENT, addressing concerns about limited exposure to the specialty in undergraduate curricula. • The model has been successfully adapted for specialised training, including emergency airway procedures (FONA), quinsy drainage simulation, and pathology-specific modifications to enhance realism in clinical training scenarios. Introduction Concerns regarding the provision of otolaryngology care out of hours by doctors in training have been documented 1 . The adoption of training models and simulators to address these concerns has become increasingly popular 2,3 . This article describes a simple cost-effective approach to manufacturing a homemade trainer which allows for the practice of a wide range of ENT essential skills. The trainer is portable, durable, and crafted from inexpensive, readily available materials, allowing for repeated use. Practical skills that can be practiced with this trainer include anterior and posterior nasal packing, otology skills such as microsuction and myringotomy using a microscope, flexible nasolaryngoscopy with model larynx visualisation, and tracheal stoma care with views of a model carina. Materials and Methods A Styrofoam head, obtained online, houses the nasal, otology, laryngeal, and tracheal models. Figure 1 illustrates the cavities created for the models. For the otology trainer, cavities are cored out to correspond to the auditory canals, typically using a cut 5ml plastic syringe as per the author’s preference. The right and left auditory canals are interconnected, facilitating the placement of a scope for visualising the medial aspect of the tympanic membrane, crucial for trainees practicing myringotomy and ventilation tube placement. The nasal simulator cavity is initially cored out using a single chopstick. After the head is bisected in the midline along the coronal plane, the excavation is completed. This sectioning allows for further removal of material, facilitating the accommodation of both laryngeal and tracheal stoma models. The models are constructed from several different materials. Figure 2 illustrates the simulators’ component parts. The otology trainer consists of a 5ml syringe cut to 2.5cm in length. The tympanic membrane can be fabricated from a variety of materials, with the author favouring clear tape, to which colour and pathology features can be added as needed. The nasal cavity and laryngeal model are constructed separately and then joined together before being inserted into the Styrofoam head. The nasal simulator is made from plastic oval conduit, typically used for housing electrical cables, which is readily available and costs under £1 per metre. The author utilises 20mm diameter conduit, cut to 80mm in length. The conduit can be split along the midline to accommodate an inferior turbinate model, with colour and pathology features, such as dilated vessels, added as desired. The laryngeal model is constructed using an 80mm section of 32mm diameter plastic tubing, commonly employed in plumbing and available for less than £1 per metre. The laryngeal component can be fabricated using various methods; one straightforward approach is to place a photograph of a larynx at the base of the tubing. However, the author prefers to craft a handmade laryngeal model using modelling clay, which can be hardened in a domestic oven. Colour and pathology, such as cancerous growths or fish bones, can be added to enhance realism. The tracheal model is fashioned similarly, using plastic plumbing tubing and modelling clay to create a detailed carina model. The laryngeal and nasal models are adhered together using glue. Additional components such as adenoid pad and Eustachian tube cushion models can be crafted from hot set clay and incorporated as desired (Figure 2). The assembled nasal and laryngeal models, along with the tracheal stoma model, are then positioned and glued into the Styrofoam head using polyvinyl acetate (PVA) glue (Figure 3). The coronally split head, which now contains the various models, is also reassembled using PVA glue. For gluing Styrofoam, PVA is the author’s preferred adhesive, whereas a hot glue gun is recommended for all other gluing requirements. Results Panel B of Figure 3 and Figure 4 display the fully assembled essential skills trainer. Once assembly is complete, additional finishing touches can be applied, such as attaching the manikin to a drape in order to stabilise it on a desktop using large clips. The placement of hook and loop fasteners at the occipital region of the manikin and the drape enables suspension during upright procedures such as microsuction. Further enhancements include adding dilated prominent vessels to the anterior medial wall of the nasal cavity model for the demonstration and practice of cautery. Foreign bodies (FB) can be inserted and removed as required. Discussion There is a rich history of both innovation and simulation usage in otolaryngology; images of Chevalier Jackson performing a tracheotomy on a doll in the back seat of a car have been published 3 , dating back to the mid 1920s. Numerous articles describe and illustrate the use of a multitude of simulators for the practice of ENT procedures, 2,3 typically within the context of organised boot camps 4,5 . These simulators vary in terms of cost and complexity. The manikin described here is cost-effective, straightforward to construct, and reusable. It enables the teaching and practice of fundamental skills essential for those providing frontline ENT services. To date, the training device discussed has been implemented in multiple centers globally, primarily for local departmental inductions aimed at training new doctors expected to handle ENT emergencies. This induction method has proved to be popular among participants. A comparative study involving junior doctors assessed whether simulation-based teaching via an induction programme utilising this device surpassed traditional lecture-based teaching. Skills taught included microsuction, flexible nasoendoscopy, and anterior and posterior nasal packing. Results showed statistically significant reductions in anxiety and improvements in confidence for performing these procedures. Moreover, simulation-based training demonstrated greater knowledge retention compared to its lecture-based counterpart 6 . The device has also proven effective in promoting the field of ENT amongst medical students. A half-day interactive workshop utilising this device significantly enhanced third year medical students’ understanding of ENT practice, with nearly all participants showing a greater interest in pursuing a career in ENT after attending the workshop 7 . This is particularly relevant given that a survey of 26 medical schools revealed that only 53% offered compulsory ENT placements, which lasted an average of just 8 days, and notably, 10 of these schools did not provide any ENT attachment at all 8 . In addition to its existing applications, the device has been customised to accommodate specific training needs or pathologies, such as the quinsy model. This adaptation involves a prefilled balloon, simulating the abscess, positioned posteriorly and secured with a cork within a model of the oral cavity. Trainees can then practise one-handed aspiration and drainage techniques on this model. The implementation of this device in simulation-based teaching has proven effective among junior doctors, who demonstrated significant increases in confidence and decreases in anxiety. Moreover, the patients treated by these doctors experienced reduced reattendance and reaccumulation rates for the condition 9 . The device has also been adapted for Front of Neck Access (FONA) procedures in emergency airway training, including tracheostomy, cricothyroidotomy, and percutaneous tracheostomy. The study highlighted that both experienced doctors and trainees rated the model highly for its realism and effectiveness as a training tool 10 . Conclusion The ENT essential skills trainer described offers a low-cost, reusable, and highly adaptable solution for practicing and teaching key otolaryngology procedures. Its successful implementation in multiple settings and demonstrated impact on reducing trainee anxiety, improving confidence, and fostering interest in ENT as a specialty highlight its value as an accessible educational tool. Ongoing, long-term evaluation of skill retention and broader integration into formal training programs are recommended. Individuals and institutions wishing to replicate the production of this model may contact the author for technical support. There is no copyright associated with this device, nor are there any financial incentives or conflicts of interest. References 1. Sharpe D, Farboud A, Trinidade A. ‘Is that the ENT SHO?’: concerns over training and experience of juniors expected to cross-cover ENT at night. Clinical Otolaryngology . 2009;34(3):275-275. doi:10.1111/j.1749-4486.2009.01921.x2. Nogueira Júnior JF, Cruz DN. Real models and virtual simulators in otolaryngology: review of literature. Brazilian Journal of Otorhinolaryngology . 2010;76(1):129-135. doi:10.1590/S1808-869420100001000213. Deutsch ES. Simulation in Otolaryngology. Otolaryngology–Head and Neck Surgery . 2011;145(6):899-903. doi:10.1177/01945998114248624. Malekzadeh S, Malloy KM, Chu EE, Tompkins J, Battista A, Deutsch ES. ORL emergencies boot camp: using simulation to onboard residents. Laryngoscope . 2011;121(10):2114-2121. doi:10.1002/lary.221465. Deutsch ES, Malloy KM, Malekzadeh S. Simulation-based otorhinolaryngology emergencies boot camp: Part 3: Complex teamwork scenarios and conclusions. The Laryngoscope . 2014;124(7):1570-1572. doi:10.1002/lary.245706. Bhalla S, Beegun I, Awad Z, Tolley N. Simulation-based ENT induction: validation of a novel mannequin training model. The Journal of Laryngology & Otology . 2020;134(1):74-80. doi:10.1017/S00222151190026397. Arwyn-Jones J, Bhalla S, Acharya V, Beegun I, Awad Z, Tolley N. Specialty Showcase Days: Can Specialist Careers Workshops Improve The Consideration Of ENT For Medical Students? Adv Med Educ Pract . 2019;10:877-884. doi:10.2147/AMEP.S2249258. Khan MM, Saeed SR. Provision of undergraduate otorhinolaryngology teaching within General Medical Council approved UK medical schools: what is current practice? The Journal of Laryngology & Otology . 2012;126(4):340-344. doi:10.1017/S00222151110033799. Bhalla S, O’Byrne L, Beegun I, Amos D, Jones JA, Awad Z, Tolley N. “No drain, no gain”: Validation of novel quinsy simulation model. Laryngoscope Investig Otolaryngol . 2020;6(1):81-87. doi:10.1002/lio2.45310. Bhalla S, Beegun I, Hogan C, Awad Z, Tolley N. Emergency airway training: “Who are you going to FONA?” Clinical Otolaryngology . 2020;45(6):889-895. doi:10.1111/coa.13621 Information & Authors Information Version history V1 Version 1 03 March 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Authors Affiliations Abdul Rafay 0009-0002-1358-0174 [email protected] Imperial College London View all articles by this author Issa Beegun Charing Cross Hospital View all articles by this author Metrics & Citations Metrics Article Usage 285 views 99 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Abdul Rafay, Issa Beegun. The Ear, Nose and Throat Essential Skills Trainer: A Technical Note. Authorea . 03 March 2025. 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