Translation of 3D technologies for personalised medicine in Otology

Abstract

Surgeons constantly need to customize or personalize solutions to suit the unique 3D (3 Dimensional) challenges each patient presents. Technologies such as 3D printing which enables delivery of customized or personalized medicine can play an important role in surgery. 3D tools have played an important role in Otology for many decades. However, despite a significant volume of literature in this area validating its benefit, 3D technologies are not part of routine clinical care. Why is this so? This PhD examines the challenges and feasibility of clinical translation of personalized medicine in Otology by methodically studying applications in the outer, middle and inner ear. It includes a narrative review of 3D technologies in Otology, a 3D visualization study of the human vestibule (an inner ear application), a feasibility study of 3D printing for ossiculoplasty surgery (a middle ear application) and an animal trial to study 3D bioprinting for chondrogenesis in microtia reconstruction (an outer ear application). It also assesses the non-technical challenges for clinical translation of personalized surgery in Otology namely; regulatory and ethical barriers. There are both specialty and technology specific barriers but due to the anatomical constraints in Otology, there are limitations in overcoming specialty specific barriers. Technology specific barriers are easier to overcome in the outer ear as it is larger in size and easier to be visualized. This region sees more advanced application of personalized medicine such as bioprinting. Though further work to apply bioprinting in the middle ear is required, 3D printing applications can assist in improving surgical outcomes. For potential application of precision medicine to the inner ear, future developments in other developing technologies such as nanoscience is necessary. In the interim, 3D anatomical studies on the inner ear can overcome smaller challenges to assist this translation.