About LAByrinth

Our Mission

Temporal bone dissection is the foundation of otologic surgical training. Every otolaryngology resident and neurotology fellow must develop proficiency in drilling the temporal bone before operating on patients — yet expert supervision is inconsistent, and the quality of feedback trainees receive varies enormously between programs and sessions.

LAByrinth delivers a structured, case-based surgical curriculum with asynchronous feedback from faculty experts. Whether trainees are working with cadaveric bones or 3D printed models, in a dedicated temporal bone lab or a portable setup, LAByrinth provides consistent, expert-caliber assessment at every stage of their dissection.

The Curriculum

Traditional temporal bone training follows a generic anatomical dissection sequence — cortical mastoidectomy, facial recess, labyrinthectomy — disconnected from clinical decision-making. Trainees learn to identify structures but not to make surgical judgments in the context of real cases. LAByrinth's case-based curriculum changes that: each bone represents a patient with a clinical story, and the learner progresses through a narrative with escalating complexity, making the same decisions they would face in the operating room.

Fourteen cases cover the breadth of otologic and neurotologic surgery — from cochlear implantation to lateral temporal bone resection. Every case begins with cortical mastoidectomy, so any trainee at any level can start any bone. Clinical context drives every step: “The electrode won't advance — now what?” Traditional anatomical dissection remains available as one of the training modules, but the emphasis is on building surgical judgment, not just anatomical recognition.

The same case narrative can be served by multiple bones with different anatomical characteristics — whether cadaveric or 3D printed — building clinical adaptability through varied repetition rather than rote memorization.

HNLE — Heuristic Neurotologic Learning Environment

HNLE (pronounced “Henle”) is the AI assistant we are developing to extend expert feedback. It is not yet used to grade submissions: every dissection is reviewed by a faculty instructor.

Named for the spine of Henle — the first landmark identified in every mastoidectomy and the starting point of every surgeon's journey — HNLE will be trained on expert reference dissections and annotated learner mistakes, refined through instructor review and administrative oversight.

The “H” in HNLE stands for heuristic — learning through trial and error, discovery, and self-directed exploration. HNLE will be an aid to that process: giving trainees access to structured feedback when an expert isn't in the room, so they can drill more often and learn from each attempt. It is not intended to replace — and we don't believe it ever could replace — the mentor-mentee relationship at the heart of surgical apprenticeship, or the irreplaceable learning that comes from clinical care and real patients. HNLE will be a supplement to that tradition, not a substitute for it.

Our Team

LAByrinth was created by Tiffany Hwa, MD, a neurotologist at the University of Pennsylvania Department of Otorhinolaryngology. You can learn more about Dr. Hwa's work at the Hwa Lab.