University of Cincinnati Academic Health Center, Cincinnati, OH, USA

■ OBJECTIVES: Programmatic standardization and benchmark parametric evaluation of resident performance has become a cornerstone in U.S. ACGME recognized training programs. To optimize resident education, training, and assessment surgical outcomes and the techniques employed to achieve a high level of success require close scrutiny, as well as, flexibility in application. This review examines the evolution of resident otologic training in mastoidectomy over a quarter century period at the University of Cincinnati, a tertiary care referral center and training program.

■ METHODS: Retrospective case log review of 3795 procedures.

■ RESULTS: Severe adverse events were uncommon, including: anacusis (6), immediate onset facial paralysis due to direct nerve section (2), delayed facial paralysis (4), labyrinthine fistulae (1). Furthermore, violation of either the tegmental dura or posterior fossa dura occurred in 38 cases with 26 CSF leaks, venous bleeding from tears in the sigmoid sinus, petrosal sinus or jugular bulb occurred 19 times. Less severe, but more common errors included: violation of the posterior canal wall (58), transannular violation in opening the facial recess (47), and unintended reduction of the posterior canal wall laterally (42).

■ CONCLUSIONS: Close faculty supervision working with residents trained in the temporal bone lab ensure a favorable outcome in resident performed mastoid surgery.