The Goat Model for Exclusive Two Handed Endoscopic Middle Ear Surgery Training: A Novel Technique


With the popularity of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown. To develop an ex vivo animal model for exclusive endoscopic ear surgery. In an experimental study, we studied goat middle ear anatomy in 8 specimens to assess the similarity with the human middle ear as a model for two handed endoscopic ear surgery with endoscope holders. After confirming its suitability, we have developed a surgical training program for grommet insertion, canaloplasty, myringoplasty, butterfly tympanoplasty, ossiculoplasty, atticotomy. The goat model is suitable for two handed endoscopic ear surgery using endoscope holder. We describe a novel, exclusively two handed endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program will guide the trainee endoscopic ear surgeon for a step by step through the main otologic procedures to enhance his or her surgical skills.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10


  1. 1.

    Khan MM, Parab SR (2015) Concept, design and development of innovative endoscope holder system for endoscopic otolaryngological surgeries. Indian J Otolaryngol Head Neck Surg 67(2):113–119

    Article  Google Scholar 

  2. 2.

    Khan MM, Parab SR (2016) Novel concept of attaching endoscope holder to microscope for two handed endoscopic tympanoplasty. Indian J Otolaryngol Head Neck Surg 68(2):230–240

    Article  Google Scholar 

  3. 3.

    Khan MM, Parab SR (2016) Endoscopic cartilage tympanoplasty: a two-handed technique using an endoscope holder. Laryngoscope 126:1893–1898.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Khan MM, Parab SR (2015) Average thickness of tragal cartilage for slicing techniques in tympanoplasty. J Laryngol Otol 129(05):435–439

    CAS  Article  Google Scholar 

  5. 5.

    Scott DJ (2006) Patient safety, competency, and the future of surgical simulation. Simul Healthc 1(3):164–170

    Article  Google Scholar 

  6. 6.

    Anschuetz MDL et al (2017) An ovine model for exclusive endoscopic ear surgery. JAMA Otolaryngol Head Neck Surg 143(3):247–252.

    Article  PubMed  Google Scholar 

  7. 7.

    Presutti L, Marchioni D, Mattioli F, Villari D, Alicandri-Ciufelli M (2008) Endoscopic management of acquired cholesteatoma: our experience. J Otolaryngol Head Neck Surg 37(4):481–487

    PubMed  Google Scholar 

  8. 8.

    Gurr A, Pearson MD, Dazert S (2011) Lambs’ temporal bone anatomy under didactic aspects. Braz J Otorhinolaryngol 77(1):51–57

    Article  Google Scholar 

  9. 9.

    Ianacone DC, Gnadt BJ, Isaacson G (2016) Ex vivo ovine model for head and neck surgical simulation. Am J Otolaryngol 37(3):272–278

    Article  Google Scholar 

  10. 10.

    Gocer C, Eryilmaz A, Genc U, Dagli M, Karabulut H, Iriz A (2007) An alternative model for stapedectomy training in residency program: sheep cadaver ear. Eur Arch Otorhinolaryngol 264(12):1409–1412

    Article  Google Scholar 

  11. 11.

    Cordero A, del Mar Medina M, Alonso A, Labatut T (2011) Stapedectomy in sheep: an animal model for surgical training. Otol Neurotol 32(5):742–747

    Article  Google Scholar 

  12. 12.

    Schnabl J, Glueckert R, Feuchtner G et al (2012) Sheep as a large animal model for middle and inner ear implantable hearing devices: a feasibility study in cadavers. Otol Neurotol 33(3):481–489

    Article  Google Scholar 

  13. 13.

    Mantokoudis G, Huth ME, Weisstanner C et al (2016) Lamb temporal bone as a surgical training model of round window cochlear implant electrode insertion. Otol Neurotol 37(1):52–56

    Article  Google Scholar 

  14. 14.

    Seibel VA, Lavinsky L, De Oliveira JA (2006) Morphometric study of the external and middle ear anatomy in sheep: a possible model for ear experiments. Clin Anat 19(6):503–509

    Article  Google Scholar 

  15. 15.

    Seibel VA, Lavinsky L, Irion K (2006) CT-scan sheep and human inner ear morphometric comparison. Braz J Otorhinolaryngol 72(3):370–376

    Article  Google Scholar 

  16. 16.

    Parab SR, Khan MM (2018) Minimal invasive endoscopic ear surgery: a two handed technique. Indian J Otolaryngol Head Neck Surg.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Parab SR, Khan MM (2018) New cartilage slicer for slicing techniques in tympanoplasty: design and applications. Indian J Otolaryngol Head Neck Surg 20:22–25.

    Article  Google Scholar 

  18. 18.

    Wang MC, Yu EC, Shiao AS, Liao WH, Liu CY (2009) The costs and quality of operative training for residents in tympanoplasty type I. Acta Otolaryngol 129(5):512–515

    Article  Google Scholar 

  19. 19.

    Connors RC, Doty JR, Bull DA, May HT, Fullerton DA, Robbins RC (2009) Effect of work-hour restriction on operative experience in cardiothoracic surgical residency training. J Thorac Cardiovasc Surg 137(3):710–713

    Article  Google Scholar 

  20. 20.

    Harris JP, Osborne E (1990) A survey of otologic training in US residency programs. Arch Otolaryngol Head Neck Surg 116(3):342–344

    CAS  Article  Google Scholar 

  21. 21.

    Pothier DD (2013) Introducing endoscopic ear surgery into practice. Otolaryngol Clin North Am 46(2):245–255

    Article  Google Scholar 

Download references


This study was not financially supported from external sources.

Author information



Corresponding author

Correspondence to Sapna R. Parab.

Ethics declarations

Conflict of interest


Ethical Approval

Institutional Ethics Committee has approved the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zaidi, A., Khan, M.M. & Parab, S.R. The Goat Model for Exclusive Two Handed Endoscopic Middle Ear Surgery Training: A Novel Technique. Indian J Otolaryngol Head Neck Surg 71, 1478–1484 (2019).

Download citation


  • Goat model
  • Middle ear anatomy
  • Two handed endoscopic ear surgery
  • Endoscope holders