{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:05:39Z","timestamp":1757617539954,"version":"3.44.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To demonstrate the feasibility and impact of auditory feedback in flexible fiberoptic nasolaryngoscopy (FNL) training with a novel model incorporating audio triggers based on known anatomical loci of negative patient feedback.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This proof\u2010of\u2010concept study used a CT\u2010based 3D\u2010printed and silicone\u2010casted model of nares to mainstem bronchi to teach FNL during an otolaryngology simulation training. The spatially tracked laryngoscope tip triggered simulated responses (pain, gag, cough) when co\u2010localized to specific anatomic landmarks: the nasal septum, epiglottis, and trachea. Participants wearing heart rate (HR) monitors completed three FNL trials, two without and one with auditory patient responses. Outcomes, stratified by prior trainee experience, included participant HR, survey\u2010based changes in confidence, and assessment of auditory feedback utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010nine trainees ranging from medical students to fourth\u2010year otolaryngology residents rated model realism and tactile experience 7.4\u2009\u00b1\u20091.6 and 6.9\u2009\u00b1\u20092.2, respectively, on a 10\u2010point Likert scale (mean\u2009\u00b1\u2009standard deviation). Average HR increased from resting baseline during all trials, decreased during the second trial, and increased in the final trial that included audio feedback (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). The least\u2010experienced participants reported the greatest change in confidence (novice: +175%, low: +165%, intermediate: +73%, experienced: +13%). All trainees felt auditory feedback added value and improved fidelity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Heart rate increased from baseline during simulated FNL on a novel 3D\u2010printed model, implying sympathetic activation and increased stress. HR decreased with repetition, implying improved comfort, but increased with simulated auditory patient responses, suggesting that patient feedback can increase trainee attentiveness. Future studies may analyze the widespread implementation of this model for multi\u2010disciplinary learners.<\/jats:p><jats:p>Level of Evidence: N\/A.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.32231","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T09:28:23Z","timestamp":1746696503000},"page":"3240-3247","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feedback Enhances Training and Elicits Biometric Responses in Novel Flexible Nasolaryngoscopy Model"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1577-8141","authenticated-orcid":false,"given":"Felix E.","family":"Fern\u00e1ndez\u2010Penny","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of Washington  Seattle Washington USA"},{"name":"Pritzker School of Medicine University of Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6869-3339","authenticated-orcid":false,"given":"Anna Christina","family":"Clements","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of Washington  Seattle Washington USA"},{"name":"University of Washington School of Medicine University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1112-2674","authenticated-orcid":false,"given":"Tanya K.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of Washington  Seattle Washington USA"},{"name":"University of Washington School of Medicine University of Washington  Seattle Washington 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