Design and development of next generation 3D-printed simulators for advanced ear surgery training

Aim: This PhD program aimed to develop a comprehensive simulation platform for ear surgery based on next-generation, patient-specific, mono- and multi-material 3D-printed models. The platform combines high anatomical fidelity and functional realism with the ability to simulate real pathological conditions using microscopic, endoscopic, and exoscopic visualization systems. Methods: The project was conducted through a collaboration between the Unit of Otorhinolaryngology and Audiology of the IRCCS Policlinico di Sant’Orsola and the eDIMES Lab Research and Study Center. Imaging data were segmented to generate anatomical 3D models optimized for 3D-printing and post-processing. Five simulators were developed: the 3D Stapes Trainer (3DST), the Ossiculoplasty (OPL) Station, the OtoMicroSim, the FACSim, and the PECSim. Pathological variants (far-advanced otosclerosis and internal auditory canal acoustic neuroma) and a pediatric version for cochlear implantation were included. Validation occurred through structured dissection sessions and international training courses (BOSS, BEMEES, ENT Endoscopy Lausanne), assessing anatomical accuracy, haptic feedback, and educational utility. Results: All simulators achieved high anatomical fidelity and satisfactory tactile realism, enabling realistic replication of standard otologic procedures. Quantitative and qualitative results were collected across different training experiences. Conclusion: The project demonstrates the feasibility and effectiveness of 3D-printed otologic simulators as a sustainable and effective alternative to cadaveric dissection. This platform establishes a foundation for integrating 3D printing into otologic training.