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First Ever Resident Temporal Bone Course at Houston Methodist is Successful

As one of Houston Methodist’s neurotologists, Kenny Lin, MD, recently took on the important task of teaching the Department of Otolaryngology – Head & Neck Surgery’s resident temporal bone course. The course is a requirement of all otolaryngology residency programs and offers residents a hand-on opportunity to practice middle ear surgery and surgical drilling through the mastoid bone to master the surgical anatomy of the ear. “Drilling of the mastoid bone is sometimes described as sculpting in reverse,” Lin said. “In sculpting, you are taking a block of stone, and you’re creating something that has a shape and a form. With ear surgery, it’s already there – the form, the structure and the anatomy. You are drilling and looking, trying to identify, preserve and define each of these structures.”

Kenny Lin, MD

In that space behind the mastoid bone, the surgeon must find and protect the bone separating the ear from the brain, major blood vessels, the facial nerve, the organs for hearing and balance, and bones of hearing. The course itself involves a variety of specialized equipment, microscopes and drills. It was held in Houston Methodist’s MITIE in April and deemed highly successful by students, proctors and Lin. Luckily MITIE (Methodist Institute for Technology, Innovation and Education) led the way with the procurement of equipment and specimens and was the ideal lab location for the course.

“This year, because our residency is still new and growing, we had about eight in attendance including our two new residents, other invited residents and one medical student who is now one of our current residents,” Lin said. “It was a good size to start, but, in time, it’s going to expand to include our full complement of 10 residents, so we’ll have a minimum of 15 to 18 people in the course.” The course will be held once a year and eventually will become a public course open to others who qualify, especially within the Texas Medical Center. This year, the course used four temporal bones from cadavers as well as 3D-printed bones. Lin and the others used the course to judge whether the 3D-printed version of the temporal bone would be as good as human bones. The 3D-printed bones are more affordable, and they don’t fall under the same regulations for handling and disposal because they are not human specimens.

MITIE was an ideal location for the temporal bone course.

“We found they were cheaper and easier to procure but did not have the same tactile feel as real bone. Good, but not quite the same,” Lin said. “Our conclusion was that, for early-stage residents, they can be a good replacement to teach the basics, such as where the anatomical relationships are. But you can’t really teach some of the nuances.” Students specifically learned how to handle the instruments during surgery. They learned to angle and position their bodies relative to the microscope. They received training specific to various procedures so they would be more experienced before performing these operations on humans. “These are things you don’t think about until you’re sitting there, trying to get a view into the middle ear that you’ve only read about,” Lin said. The goal of the program over the next year will be to expand the scope of this initial course. This year, there were five stations. Lin expects to increase to six or eight stations next year. Other residents or other doctors from outside the country will be invited. Procedures that involve going through the temporal bone include treatment of chronic ear infections, cholesteatoma and cochlear implants. In less frequent cases, the physician may have to repair leakage of brain fluid into the ear. In the lab, surgery may be performed through the ear canal to practice repair of the ear drum or reconstruction of the bones of hearing. “This experience is one of the highlights of the year for residents. It’s very hands-on and interesting,” he added. Lin is an expert in rehabilitation of hearing loss and is passionate about helping patients with diseases of the ear. He came to Houston Methodist after medical school at Washington University in St. Louis, residency at New York Presbyterian – Columbia and Cornell, and then completing the prestigious two-year fellowship in Otolaryngology and Neurotology at Michigan Ear Institute. “I thought the course was great; it went really smoothly,” Lin said. “The students all had great feedback and raved about the state-of-the-art equipment and space. It was nice to be working on new equipment rather than equipment that had been sitting in the lab space for 20 years.”

The course was supported by industry sponsors including:

Aesculap for drills and instruments
Leica Biosystems for microscopes
Cochlear Americas for cochlear implants and
Grace Medical for middle ear implants.