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The increasing prevalence of virtual reality simulation in temporal bone surgery warrants an investigation to assess training effectiveness.To determine if temporal bone simulator use improves mastoidectomy performance.Ovid Medline, Embase, and PubMed databases were systematically searched per the PRISMA guidelines.Inclusion criteria were peer-reviewed publications that utilized quantitative data of mastoidectomy performance following the use of a temporal bone simulator. The search was restricted to human studies published in English. Studies were excluded if they were in non-peer-reviewed format, were descriptive in nature, or failed to provide surgical performance outcomes. Meta-analysis calculations were then performed.A meta-analysis based on the random-effects model revealed an improvement in overall mastoidectomy performance following training on the temporal bone simulator. A standardized mean difference of 0.87 (95% CI, 0.38-1.35) was generated in the setting of a heterogeneous study population (I2 = 64.3%, P < .006).In the context of a diverse population of virtual reality simulation temporal bone surgery studies, meta-analysis calculations demonstrate an improvement in trainee mastoidectomy performance with virtual simulation training.