Otoscan3D is a new technology with laser light to scan the shape of the patient's ear. It provides great accuracy, but without using traditional silicones injected into the ear to copy its anatomy. It is a tool that Hearing Clinics are implementing in the last two years, and as a reference you can visit the page of one of the manufacturers: NATUS for Otoscan [1]. The novelty of Otoscan3D is not only to scanning the ears of patients who use custom hearing aids. It also has a very important use when we reproduce the auditory pavilions of patients who need reconstructive anaplastology, whether functional or aesthetic. naplastology is a interesting discipline that should be known to all audiologists. 3D Scanners applied directly inside the patient's ear are a technology which has spread rapidly. But the experience accumulated by audiologists is still small Our contribution with this article is based on the fact that we are surely the Audiology Center in Spain with more experience in digital scanning of patients' ears. And also the article is written after other previous publications/information about the new 3D Scanners; [2-4]. Therefore, the contribution with our experience in its use is twofold: It is a help and guide for audiologists who begin to use it (prevent possible mistakes) and also it is an independent and neutral source of opinion, without commercial influence or intention. We have had the opportunity to use Otoscan3D since the arrival of the first units in Spain (Spain had an early introduction to the European market of 3D scanners in Audiology). And we also participated, at the beginning of 2019, in the massive day held at the ADA-ITS facilities. There they gathered three scanners transferred to Seville (Spain), with 6 technicians scanning ears continuously and in the same session. It was carried out with the students of the automotive, avionics and aeronautics school, under the sponsorship of ICADA Seville. This Marathon of scanned ears was held in May 2019; see announcement [5]. On the other hand, we have the experience of the use of Otoscan3D by our audiologists at Audiocenter during the rest of the year 2019 and the experience in the training of the students of the School of Audioprosthesis of Seville. These students who have learned with us for their practical training cycles, and they will be the future Spanish hearing care professionals. A few months ago, we committed ourselves with our professional colleagues to give an honest and constructive point of view about our experience in the use of Otoscan3D; see [3] “Otoscan3D y nuestros seis meses de experiencia en Andalucía”s

Our seven conclusions are

• Previews of mold design.
• Epilepsy or neurological problems.
• Visual problems of the technician.
• Flexible tip of the frontal laser beam.
• Pediatric examination tip.
• The diameter of the reference ring of the patient's ear.
• Use of the K-Model type dummy to training.

Previews of mold design

Since we scanned 3D ears to send it to the mold maker, the previews that the laboratory sends us has become a very useful tool. Before, when we used silicone, we did not demand the preview (nor did they send them to us from the laboratory). Because of this, the design process became an act of “Faith” with the laboratory. It is not that we have stopped having faith in the laboratories, but now we can see (and decide) for ourselves

Figure 1: CIC Preview Virto-Phoank.

Figure 2: Head, manikin and accessories.

Epilepsy or neurological problems

The number of neurological problems associated with epilepsoid conditions are much more Frequent than we suppose: Although the manufacturer already warns about this possibility (Otoscan3D User Manual; section 2.6 "Contraindications"), the cases are not really limited to people who declare that they have "seizures or Sensitivity to strobe lights". We have found cases in which the pulsed laser light can disturb patients with no known history of epilepsy. Especially if you work in twilight or the cabinet is not very bright. Solution: Include this inquiry in Anamnesis and safeguard us by discarding those patients. And just in case, try to alleviate the feeling for others by lighting up the cabinet at the time of taking the measurement. And conclusion: this shows that there are many more cases of neurological problems than we think, at any age.

Visual problems of the technician

The laser strobe is intense and highly focused. This causes problems for the technicians who perform the measurement when that is added with presbyopia, forias and convergence problems in close distances. We haven't got any solution yet, but we are testing the use of protective type glasses with color filter lenses. Maybe the manufacturer should include something of this type in the standard equipment accessories.

The flexible tip of the front beam

The tip of the beam is rigid. In some patients with especially difficult ducts, a tip of transparent but softer material, would be desirable. We understand that nowadays the concept of "flexible tip" is still too advanced and technically complex, due to the difficulty of driving the front laser beam. But, something more "soft" would be desirable.

The pediatric tip

We think this issue is closer to being achieved. A smaller tip for smaller ears.

The goal is to allow easier use with children's ears. Although the manufacturer indicates in the instructions (page 6 of the Otoscan3D User Manual; section 2.4 “Expected patient population”), that the age of application is 18 years and older (as legal safeguard), it is not clear if it is the age who limits the machine or the machine who limits the age. We believe that a minor tip would be useful.

The diameter of the Hoop

This is the opposite case: big ears. The diameter of the ring, which is still fixed and limited (because it is determined by the distance between the positioning cameras for the reference marks), is sometimes insufficient. This causes the ear not to be in its natural position. If the ear is in a forced position and/or covering any of the references of the hoop to the cameras, they "become disoriented" without those marks. Consequence: The measurement of that large ear becomes difficult.

Use of the manikin dummy and other accessories

The Otoscan3D brings a pedestal ear so technicians can practice. And that ear is included as an accessory by the manufacturer. But, if you have students or inexperienced technicians in the process of training, the use of test heads and mannequins for learning and practices becomes very necessary [4,5]; Why use anatomical models with the Otoscan 3D? Another aspect is also very important: A hydraulic and adjustable chair. This makes patient management much easier and facilitates access to the patient's duct. Finally, the use of a large screen of at least 42 inches minimum is also very important. The system brings a computer, but its screen is too small.

1. Otoscan.
2. Barbero A. State of the art and future trends on the measurements of the patient´s ear in the audiologic and anaplastology implementatio of new technologies of 3D inside-the-canal auditory scanners. Otolaryngol. 2019; 9: 369.
3. Audiocenter Otoscan3D and our six months of experience in Andalusia. 2019.
4. Audiocenter Why use anatomical models with the Otoscan 3D.
5. Audiocenter world record with Otoscan3D.