@article{AJO5222,
author = {Gideon Richard Budiono and King Or and Kiao Inthavong and Narinder Singh},
title = {Eye-tracking differences between expert and novice gaze in otolaryngology: a systematic review},
journal = {Australian Journal of Otolaryngology},
volume = {9},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Eye-tracking technology is an emerging objective tool to quantify visual attention during complex tasks and has shown distinction in gaze behaviour between expert and novice clinicians across multiple specialties. In Otolaryngology, efficient visual strategies are key for safe performance within a constrained surgical field using endoscopic or microscopic views. This systematic review explores the application of eye-tracking technology in delineating expert and novice gaze behaviour differences in Otolaryngology, with implications for surgical training and performance assessment.Methods: A comprehensive literature search was conducted from inception to January 2026 using medical and engineering databases (PubMed, EMBASE, Scopus, and IEEE Xplore), in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies examining the use of eye-tracking to evaluate gaze behaviour of healthcare professionals or trainees performing diagnostic or surgical tasks in Otolaryngology. Data were extracted on task category, Otolaryngology subspecialty, eye-tracking modality and gaze parameters. Methodological quality was examined using the Joanna Briggs Institute (JBI) checklist.Results: Six simulation-based studies spanning Rhinology, Otology, Laryngology and Head and Neck Surgery were included. Eye-tracking studies were categorised into two domains: training and assessment, predominantly focusing on performance assessment. Across subspecialties, experts and novice surgeons demonstrated consistent differences in fixation duration, fixation counts, saccades and quiet eye (QE) metrics, with experts demonstrating more efficient visual search behaviour during orientation tasks and more sustained fixation on task-relevant anatomical landmarks during critical procedural steps. Substantial heterogeneity in study design and expertise definitions precluded quantitative meta-analysis.Conclusions: This systematic review demonstrates consistent and reproducible differences in gaze behaviour between expert and novice surgeons across otolaryngology subspecialties. These differences reflect task-specific visual strategies such as efficiency during orientation compared with focussed attention during critical procedural steps. Eye-tracking represents a promising objective adjunct for assessing visual aspects of surgical expertise and supporting gaze-guided surgical training. Future validation in live operative environments is required before clinical implementation.},
issn = {2616-2792}, url = {https://www.theajo.com/article/view/5222}
}