Virtual Reality Technology in Otolaryngology Patient Care Management: A Narrative Review of Current Evidence and Future Prospects

Abstract

Virtual reality (VR), defined as an immersive, interactive, computer-generated simulation delivered via head-mounted displays that create a sense of presence in a virtual environment, holds promise for otolaryngology nursing and is increasingly used in clinical practice worldwide. This narrative review covers both patient-facing VR applications (preoperative education, pain and anxiety relief, vestibular rehabilitation, swallowing assessment and therapy, hearing rehabilitation, and tinnitus management) and nurse-facing VR applications (professional training and skills development). By synthesizing recent clinical studies and technological advances, this review highlights the potential for VR to enhance the patient care experience, improve nursing quality and efficiency, and address common challenges such as severe surgical anxiety and poor adherence to rehabilitation; supporting evidence varies across applications. Vestibular rehabilitation is supported by strong evidence from randomized controlled trials, whereas swallowing therapy and tinnitus management are primarily supported by preliminary exploratory studies. We discuss technical, economic, and clinical limitations hindering implementation of VR, then present practical recommendations for future research and clinical practice. This review also highlights recent advances, including the integration of VR with artificial intelligence, wearable biosensors, and telerehabilitation platforms, to facilitate personalized remote otolaryngology nursing. Despite the potential for VR to improve rehabilitation outcomes and treatment adherence, current evidence remains heterogeneous due to variations in study designs and outcome measures. Rigorous, standardized, large-scale studies are urgently needed to strengthen the evidence base and support the reliable, standardized implementation of VR in otolaryngology nursing. This review summarizes the current evidence and future prospects of VR in otolaryngology patient care management.

Introduction

Virtual reality (VR) is a technology that creates a fully immersive, 3-dimensional, computer-generated environment with which users can interact in real time [1]. Typically delivered via head-mounted displays with motion tracking, VR generates a sense of presence—the subjective feeling of “being there”—by engaging the user’s visual, auditory, and sometimes haptic senses. This distinguishes VR from conventional screen-based simulations and makes it particularly suitable for healthcare applications in which immersion and distraction are beneficial [2]. Potential uses of VR in otolaryngology nursing are promising, and its application has expanded across healthcare systems worldwide. This narrative review focuses on 2 distinct but complementary applications of VR in otolaryngology nursing: (1) patient-facing VR, which directly benefits patients through preoperative education, perioperative pain and anxiety relief, vestibular rehabilitation, swallowing therapy, and hearing rehabilitation; and (2) nurse-facing VR, which enhances nursing education and skills training. By covering both domains, this review provides a comprehensive overview of how VR can improve patient outcomes while simultaneously advancing nursing competencies. Here, we summarize and evaluate current VR applications in otolaryngology nursing, focusing on both established applications and recent advances in key areas, including preoperative education and scenario-based simulation, nonpharmacological management of perioperative pain and anxiety, vestibular rehabilitation with quantitative balance assessment, swallowing assessment and immersive intervention, and training for otolaryngology healthcare professionals.

Otolaryngology encompasses many conditions and interventions that often result in substantial physical discomfort and emotional distress. Common challenges include vertigo, dysphagia, postoperative pain, and anxiety. Conventional nursing approaches typically are insufficient to effectively manage these symptoms, improve patient adherence, and accelerate recovery. VR offers novel, engaging, and immersive experiences that have the potential to transform nursing practice in this field. By creating controlled and safe virtual environments, VR can divert patients’ attention, provide standardized and reproducible training modules, and recreate complex clinical scenarios for patient education and training [1]. A growing body of literature indicates that VR may provide benefits throughout the continuum of patient care, across both pediatric and adult populations, for diagnostic and therapeutic applications [3].

Recent findings suggest that VR could considerably reduce anxiety in patients undergoing office-based otolaryngologic procedures. For example, a clinical study showed that the use of VR as a distraction intervention significantly reduced anxiety in adults undergoing office-based otolaryngologic procedures compared with usual care [1]. In addition to providing distraction, VR presents preparatory information in a more engaging format, thereby improving understanding and reducing anticipatory distress, particularly in children [1].

The integration of VR into nursing education and practice also has great potential to enhance nursing competency. VR provides nursing trainees with opportunities to practice skills in simulated environments that closely resemble real-world clinical settings. Recent studies have demonstrated that nursing students using VR-based learning exhibit greater satisfaction and improved knowledge retention, particularly in anatomy [2]. The coronavirus disease 2019 (COVID-19) pandemic further highlighted the need for alternative approaches to nursing education, given that conventional hands-on training was disrupted. VR-based training has emerged as a promising alternative to address these educational challenges [3].

In summary, incorporation of VR into nursing education and clinical practice has transformative potential to improve both patient outcomes and trainee competencies. In otolaryngology nursing, VR can substantially alleviate patients’ physical and psychological burdens, enhance the patient care experience, and play an important educational role by facilitating the development of skilled and confident clinicians [4].

This narrative review aims to summarize the current evidence and future prospects of VR technology in otolaryngology patient care management, covering both patient-facing applications (preoperative education, pain and anxiety relief, vestibular rehabilitation, swallowing therapy, hearing rehabilitation, and tinnitus management) and nurse-facing applications (professional training and skills development). Where direct empirical evidence in otolaryngology nursing is limited, we incorporate evidence from related disciplines and subspecialties, clearly identifying these instances within the text. The review is organized according to the patient care pathway and key nursing domains: patient-facing applications in preoperative preparation and psychological care (Section 1), vestibular rehabilitation and balance recovery (Section 2), dysphagia assessment and management (Section 3), nurse-facing applications for nursing education and professional development (Section 4), and hearing rehabilitation and tinnitus management (Section 5). We conclude with an integrated overview of current challenges, emerging opportunities, and available evidence.

Review Methods

Our narrative synthesis followed established guidelines for qualitative literature integration. We searched PubMed/MEDLINE, CINAHL, Web of Science, and Scopus for relevant publications from January 2015 to March 2026; no language restrictions were applied during the search. Keywords included “virtual reality,” “VR,” “head-mounted display,” “immersive technology,” “otolaryngology,” “ENT,” “nursing,” “patient education,” “rehabilitation,” “balance training,” “vestibular,” “swallowing,” “dysphagia,” “tinnitus,” “hearing aid,” “cochlear implant,” “pain management,” “anxiety,” “preoperative,” “skills training,” and “nursing education.” Additionally, we manually screened the reference lists of identified articles and relevant systematic reviews to identify additional eligible studies.

We included studies that (1) described the use of VR in otolaryngology nursing or direct patient care; (2) were peer-reviewed original research articles, systematic reviews, or high-quality narrative reviews; and (3) reported clinical, patient-reported, or educational outcomes. We excluded articles that (1) were not relevant to otolaryngology nursing or clinical practice; (2) were published in languages other than English and could not be fully translated and interpreted by the research team; (3) were conference abstracts, editorials, or opinion pieces without original data; or (4) exclusively focused on surgical training for physicians without relevance to nursing practice.

Retrieved studies were grouped into 5 application categories: patient-facing preoperative education and psychological support; patient-facing VR therapy and balance training; patient-facing interventions for swallowing impairment; nurse-facing education and competency development; and patient-facing hearing rehabilitation, including tinnitus management. Because this was a narrative review, no formal quality appraisal or meta-analysis was conducted.

VR Technology in Preoperative Education and Psychological Intervention for Otolaryngology Patients (Patient-Facing)

Preoperative Education and Situational Simulation

VR technology has substantially transformed preoperative counseling in otolaryngology [4,5]. It provides patients with highly immersive and photorealistic representations of the operating room environment and surgical process [5,6]. Using head-mounted displays, VR technology can accurately recreate complex operative environments. Additionally, these virtual environments provide step-by-step animated visualizations of common ear, nose, and throat procedures (eg, nasal endoscopy, tonsillectomy, and cochlear implantation). This highly immersive experience allows patients to virtually “preview” their upcoming procedure; understand the relationship between complex surgical steps and the instruments used; and develop realistic expectations regarding the recovery timeline, potential adverse events, and other aspects of care [4,5]. A major benefit of this approach is the reduction of anxiety arising from surgical uncertainty—patients gain a better understanding of the operative process [1].

Evidence suggests that VR-enhanced education improves patient understanding of the surgical workflow, knowledge retention, and acceptance of preoperative information relative to conventional verbal and written communication [4–6]. Studies in surgical education have shown that VR heightens spatial cognition and procedural familiarity among surgical trainees, suggesting that similar benefits extend to patient-facing education [4]. Furthermore, VR enables standardized delivery of educational content, reducing communication inconsistencies that result from differences in clinicians’ explanatory styles [6].

Although current research has primarily focused on the use of VR for surgical training, an increasing number of studies are exploring its application in patient-centered care to improve the informed consent process and reduce decisional conflict [7,8]. However, additional clinical trials are needed to determine the effects of VR-based preoperative education on specific patient outcomes, including anxiety reduction, patient satisfaction, and postoperative recovery in otolaryngology [4–6].

Distraction Interventions for Anxiety and Pain

Invasive otolaryngologic procedures—especially during the postoperative period—can cause substantial anxiety and pain, particularly in children undergoing procedures such as nasopharyngoscopy, wound dressing changes, or tympanostomy tube placement [1,9]. VR provides a powerful nonpharmacological approach to managing these symptoms through immersive distraction [1]. By engaging patients with interactive games, calming virtual environments, or guided meditation programs, VR captures attention and diverts cognitive processing away from pain and anxiety. This mechanism is commonly explained by the gate control theory, in which attentional engagement with VR competes with pain and anxiety signals at neural “gates,” resulting in lower pain ratings on the Visual Analog Scale and reduced anxiety scores, such as those measured by the State-Trait Anxiety Inventory [1,9].

Clinical studies have shown that children recovering from tonsillectomy who received VR-based distraction required fewer postoperative analgesics and experienced less distress and fewer crying episodes [1]. The immersive nature of VR provides a pleasant, low-risk alternative to pharmacological interventions; it may reduce opioid use and associated adverse effects [1].

In addition to immediate distraction, VR may enhance patients’ sense of control and psychological resilience during anxiety-provoking procedures [8,9]. Although the clinical potential of VR is encouraging, logistical challenges—including equipment costs, patient selection, and personnel training—must be addressed before it can be widely integrated into routine otolaryngology care [10,11].

Section Summary: Current Evidence and Research Gaps

Collectively, VR interventions for preoperative preparation have considerable potential to improve children’s understanding of procedures and reduce preoperative anxiety [1,4,5]. A summary of the current evidence and remaining research gaps is provided in Table 1.

Table 1.

Summary of evidence for virtual reality in preoperative education and psychological intervention.

Aspect	Key findings	Evidence level	Major limitations
Preoperative education	Improved understanding, reduced anxiety, and enhanced patient satisfaction	Moderate (RCTs, quasi-experimental studies)	Small sample sizes (30–120 participants), short follow-up, heterogeneous control groups
Distraction for pain and anxiety	Consistent reduction in anxiety; less consistent pain relief	Moderate for anxiety; low to moderate for pain	Optimal timing and duration remain unknown; few comparisons with established distraction methods

Note: RCT, randomized controlled trial.

The benefits of VR for pain and anxiety relief have primarily been shown in randomized trials, supporting its use as an effective adjunctive nonpharmacological intervention, particularly for pediatric patients. However, the evidence is less consistent for pain reduction than for anxiety reduction [1]. Important questions remain concerning the optimal timing and duration of VR interventions, their long-term postoperative effects, and their cost-effectiveness relative to existing standards of care. Future studies should directly compare VR with established distraction strategies (eg, music and guided imagery) and rigorously evaluate clinically meaningful outcomes, including length of hospital stay and postoperative opioid consumption [1,11].

The available literature predominantly consists of randomized controlled trials (RCTs) and quasi-experimental studies. Sample sizes are generally small (30–120 participants per study) [4,6], and follow-up is typically limited to the immediate post-intervention period or within 1 week post-procedure. Control groups are heterogeneous; they include standard care, tablet-based education, and music-based distraction. The most consistent finding is a reduction in self-reported anxiety scores (eg, State-Trait Anxiety Inventory), whereas effects on pain and patient satisfaction remain ambiguous. Some supporting evidence is extrapolated from non-otolaryngology populations. Additionally, the distinction between feasibility studies and confirmatory clinical trials remains unclear, and few studies are adequately powered to detect clinically meaningful differences [1,4,8].

Future research should prioritize multicenter RCTs with larger sample sizes, longer follow-up (≥ 3 months), and standardized outcome measures, including postoperative opioid use and length of hospital stay.

VR Technology in Vestibular Rehabilitation and Balance Function Training (Patient-Facing)

Customized Vestibular Rehabilitation Programs

VR technology facilitates the development of individualized vestibular rehabilitation programs and offers distinct advantages for patients with balance disorders caused by common vestibular conditions, including benign paroxysmal positional vertigo and vestibular neuritis. VR enables the creation of controlled, progressively challenging visual-motion environments that provide realistic rehabilitation tasks, such as walking on unstable paths or navigating an immersive virtual supermarket. Within these fully immersive environments, key visual stimulus parameters—including movement speed, direction of motion, and environmental complexity—can be adjusted precisely and dynamically. Such flexibility allows rehabilitation programs to be tailored to each patient’s symptom tolerance and real-time progress, supporting personalized, stage-specific vestibular rehabilitation [12].

This adaptability enables the rehabilitation program to evolve as the patient’s functional abilities improve. Relative to conventional exercises, such as the Cawthorne-Cooksey and Brandt-Daroff protocols, VR-based training provides greater engagement through increased interactivity and task complexity [12]. For example, an RCT of patients with persistent symptoms after canalith repositioning demonstrated that comprehensive VR-based vestibular rehabilitation produced greater improvements in symptoms, as measured by the Dizziness Handicap Inventory and Vestibular Symptom Index, than conventional exercise programs [12]. The interactive and immersive nature of VR-based exercises promotes patient engagement, whereas real-time biofeedback enables patients to immediately assess and adjust their performance, thus facilitating motor learning and vestibular compensation [12].

VR platforms can also integrate multisensory inputs to recreate complex environments that stimulate the vestibular system more effectively than conventional static exercises [13,14]. Specialized military VR vestibular rehabilitation systems incorporate cognitive-motor tasks designed to reflect operational demands, improving gaze stability, balance, and sensorimotor integration in service members with mild traumatic brain injury (mTBI) [13]. Additionally, the adaptability of VR allows precise control of visually induced stress, which is important given that stress influences the integration of sensory information required for postural stability. Evidence suggests that calming virtual environments can enhance vestibular rehabilitation outcomes, whereas stress-inducing environments may be more beneficial for somatosensory rehabilitation, underscoring the importance of carefully selecting virtual environments for vestibular rehabilitation [14].

Customization also extends to the level of immersion. Research indicates that immersive VR interventions provide greater improvement in vertigo symptoms compared with non-immersive VR [15]. For optimal outcomes, immersive VR programs should use shorter session durations (ideally < 30 minutes), higher treatment frequencies (≥ 5 sessions per week), and intervention periods of up to 7 weeks [16]. Studies of patients with peripheral vestibular hypofunction indicate that immersive VR rehabilitation delivered at least 5 times per week for no more than 7 weeks can substantially improve postural control and quality of life [16].

Nevertheless, these conclusions are based on single-center studies with small sample sizes and thus cannot be generalized to other vestibular disorders, such as central vertigo [15,16]. VR also reduces the repetitiveness typically associated with vestibular exercises, helping to maintain patient engagement and improve adherence [17]. Overall, VR enables highly personalized vestibular rehabilitation via structured, progressive, multisensory stimulation, leading to improved clinical outcomes [12,14,16].

Balance Function Assessment and Quantification

The integration of VR with motion capture technology has substantially advanced the objective assessment and quantification of balance function in patients with vestibular disorders [18,19]. Conventional clinical assessments rely on subjective reporting and static evaluations, which may fail to detect subtle balance impairments. In contrast, VR-based assessment systems provide controlled, dynamic, and visually stimulating environments that activate vestibular and postural control pathways while generating quantifiable performance data [18,20].

When combined with motion capture systems and force platforms, VR enables measurement of postural sway, center of pressure trajectories, compensatory movements, and balance strategies under a range of sensory conditions [18,19]. For example, VR tasks such as standing on a swaying virtual plank or navigating visually complex environments can reveal balance deficits that may not be apparent during conventional standing assessments [18]. Quantitative outcome measures include center of pressure velocity, sway area, sway path length, and gait parameters such as stride velocity and turning time [19,20]. These metrics can detect balance impairments associated with benign paroxysmal positional vertigo and peripheral vestibular hypofunction. For instance, personalized VR-based vestibular rehabilitation combined with canalith repositioning has been shown to improve gait parameters measured using portable mobility sensors [19]. VR-assisted balance assessments can also be used to monitor recovery after canalith repositioning in patients with benign paroxysmal positional vertigo [20].

Sensory organization tests performed in VR environments reveal differential effects of visual information on balance control, highlighting the need for individualized treatment strategies [14]. VR-based assessments can also incorporate dual-task paradigms and cognitive testing, allowing a more comprehensive evaluation of balance under real-world conditions, particularly in older adults with mild cognitive impairment or frailty [21].

VR-based balance assessment tools are reliable and sensitive, enabling clinicians to objectively quantify rehabilitation outcomes and adjust treatment accordingly [18,20]. Real-time biofeedback and game-based tasks further enhance assessment by actively engaging patients. The integration of VR with motion capture and sensory manipulation provides a comprehensive, quantitative platform for balance function assessment [18,19].

Section Summary: Current Evidence and Research Gaps

VR-based vestibular rehabilitation has demonstrated significantly greater patient engagement and adherence than conventional exercise programs in moderate- to high-quality RCTs [12,16]. A summary of the current evidence and remaining research gaps is presented in Table 2. The primary advantages of VR include adaptable visual-vestibular stimulation, real-time biofeedback, and objective balance monitoring. However, substantial variability in intervention protocols—including session frequency, treatment duration, and level of immersion—limits direct comparisons across studies. Furthermore, evidence remains limited for well-defined patient populations, such as older adults with multifactorial balance impairment and individuals with post-concussive syndrome [13,21]. Standardized outcome measures and multicenter studies are needed to support evidence-based clinical recommendations [15,16].

Table 2.

Summary of evidence for virtual reality in vestibular rehabilitation and balance assessment.

Aspect	Key findings	Evidence level	Major limitations
Customized rehabilitation	Greater patient engagement and adherence; improved DHI and VSI scores	High (multiple RCTs and systematic reviews)	Heterogeneous intervention protocols; predominantly small, single-center studies; limited generalizability to central vestibular disorders
Balance assessment	Objective, quantitative assessment of balance function (COP and gait parameters)	Moderate to high (validated in clinical studies)	Lack of standardized protocols; limited multicenter validation

Note: COP, center of pressure; DHI, Dizziness Handicap Inventory; VSI, Vestibular Symptom Index.

This application area has the strongest evidence base among current VR interventions, supported by numerous RCTs and systematic reviews. Study populations range from approximately 40 to more than 200 participants [12,16,19], with follow-up periods of 4 weeks to 6 months. Limitations include heterogeneity in intervention protocols, absence of blinded outcome assessment in some trials, and predominance of single-center studies. The most consistent findings are improvements in Dizziness Handicap Inventory scores and posturographic measures. Evidence for specific subgroups, such as older adults and patients with post-concussive syndrome, remains limited. Moreover, some studies have used non-immersive VR systems or proprietary software platforms, limiting the generalizability of findings to commercially available VR headsets [15,16].

Future research should establish standardized rehabilitation protocols (eg, treatment dose, session frequency, and level of immersion) and conduct multicenter RCTs comparing VR with conventional vestibular rehabilitation. Long-term follow-up (≥ 6 months) and cost-effectiveness analyses should also be incorporated.

VR Technology in the Assessment and Treatment of Swallowing Disorders (Patient-Facing)

Contextualized Assessment of Swallowing Function

Conventional swallowing assessments, such as the videofluoroscopic swallowing study, are performed in standardized clinical settings that do not replicate real-world eating environments. This limitation reduces ecological validity and may underestimate the influence of psychological and social factors on swallowing performance [22]. VR systems can simulate diverse social dining environments (eg, family gatherings and restaurant settings), providing an ecologically valid and psychologically realistic context for swallowing assessment [22,23]. Within these immersive environments, clinicians can detect subtle changes in swallowing behavior and anxiety-induced avoidance patterns that may be overlooked during conventional assessments [22].

For example, VR can recreate the social pressures and distractions associated with group meals that may exacerbate swallowing difficulties or trigger maladaptive behaviors. VR can also present virtual foods with different textures and consistencies, allowing clinicians to monitor response times and patients’ willingness to initiate swallowing. Such behavioral observations complement physiological assessments and facilitate a more comprehensive understanding of swallowing disorders as conditions influenced by physical, cognitive, and emotional factors [22,23]. Recent advances (eg, swallowing computed tomography combined with VR visualization) have proven useful for identifying subtle causes of swallowing symptoms, including laryngeal clicking [22].

Another advantage of VR-based assessment is its ability to help differentiate the underlying causes of globus sensation and throat discomfort during swallowing, thus improving diagnostic accuracy and patient satisfaction [22]. By evaluating swallowing under ecologically valid conditions and providing quantifiable behavioral data, VR-based assessments represent a substantial advancement over conventional assessments conducted in a single clinical environment [22,23].

Immersive Swallowing Therapy Training

Immersive VR offers an active therapeutic approach for swallowing disorders and has the potential to transform conventional rehabilitation strategies [23]. Custom-designed interactive VR training programs encourage patients to perform goal-oriented tasks that emphasize orofacial and swallowing-related movements. For example, patients may control a virtual character by performing precise head or tongue movements to “consume” virtual food items. This game-based approach transforms repetitive muscle-strengthening exercises into engaging activities, potentially improving treatment adherence and rehabilitation effectiveness. Such VR interventions may also promote motor learning and neuroplasticity [23].

For psychogenic swallowing disorders (eg, globus pharyngeus), VR can be combined with relaxation techniques in calming virtual environments. Patients can be guided through progressive muscle relaxation and guided imagery involving swallowing movements, thereby reducing laryngeal tension and anxiety and potentially improving symptoms. This integrated approach addresses both the physical and psychological components of swallowing disorders. Immersive VR has also been shown to improve swallowing function and patient satisfaction during stroke rehabilitation [23]. Additionally, VR-based therapies can be personalized to target specific functional deficits while providing real-time feedback and adaptive adjustments throughout treatment [23].

However, current evidence is primarily derived from stroke rehabilitation studies with small sample sizes (n ≤ 30) and short follow-up periods (≤ 2 weeks) [23]. Data specific to dysphagia in otolaryngology, such as swallowing dysfunction after laryngectomy or treatment for head and neck cancer, remain extremely limited. Future research should establish standardized treatment protocols, evaluate long-term effectiveness, and investigate the integration of VR with multidisciplinary rehabilitation approaches [22,23].

Section Summary: Current Evidence and Research Gaps

VR has the potential to provide innovative methods for the ecologically valid assessment of swallowing function and to deliver immersive, gamified swallowing therapy through orofacial training [22,23]. A summary of the current evidence and remaining research gaps is presented in Table 3. Clinical applications remains in early stages; published literature primarily consists of proof-of-concept studies and small case series. Major knowledge gaps include the absence of validated VR-specific swallowing assessment tools, limited dose-response data, and the infrequent incorporation of objective physiological measures (eg, manometry and electromyography). Future research should prioritize standardized VR assessment protocols and well-designed RCTs comparing VR-based interventions with conventional swallowing therapy, particularly for post-stroke dysphagia [22,23].

Table 3.

Summary of evidence for virtual reality in swallowing disorders.

Aspect	Key findings	Evidence level	Major limitations
Contextualized assessment	High ecological validity; captures behavioral aspects of swallowing	Preliminary (proof-of-concept studies and small case series)	No validated VR-specific assessment tools; small sample sizes (5–30 participants)
Immersive therapy	Improved patient engagement and satisfaction; potential to promote motor learning	Low (primarily extrapolated from stroke rehabilitation studies)	No RCTs in otolaryngology-specific dysphagia; short follow-up (≤ 2 weeks)

Note: RCT, randomized controlled trial; VR, virtual reality.

The current evidence base is limited and predominantly consists of proof-of-concept studies, case series with small sample sizes (n = 5–30) [22], and a small number of quasi-experimental studies; no large RCTs have been published. Follow-up periods are generally short, ranging from the immediate post-intervention period to 2 weeks. Many studies also lack concurrent control groups. The most consistent positive findings are related to better patient engagement and satisfaction, rather than objective physiological improvements in swallowing function. Most evidence has been extrapolated from stroke rehabilitation, with very limited direct evidence for otolaryngology-specific conditions, such as dysphagia after laryngectomy or treatment for head and neck cancer. To date, no validated VR-based swallowing assessment tool is available [22,23].

Future studies should develop and validate VR-based swallowing assessment tools against established reference standards (eg, videofluoroscopic swallowing study and fiberoptic endoscopic evaluation of swallowing). Additionally, well-designed RCTs should evaluate VR interventions in otolaryngology-specific dysphagia populations, including patients who have undergone laryngectomy or treatment for head and neck cancer, using objective physiological outcome measures.

VR in Education and Skills Training for Otolaryngology Nursing Staff (Nurse-Facing)

High-Risk Procedural Skills Simulation Training

VR provides a valuable platform for training high-risk procedural skills in otolaryngology nursing education, particularly for emergency situations and specialized nursing procedures that are difficult to practice in real clinical settings [11,24]. VR can realistically simulate critical scenarios, including epistaxis, airway foreign body management, and postoperative hemorrhage [11]. These immersive simulations allow nurses to practice complex clinical situations without risking patient safety. For example, VR-based scenarios guide nurses through comprehensive crisis management, enabling them to rehearse clinical decision-making, technical skills (eg, tracheostomy care and suctioning), and teamwork. This approach is particularly valuable because opportunities for hands-on experience are often limited by patient safety considerations and the infrequent occurrence of such events [11].

A substantial benefit of VR is the opportunity for repeated practice of challenging procedures in a risk-free environment with immediate feedback on errors and performance metrics (eg, instrument trajectory and procedure completion time), thereby promoting skill acquisition and retention. For instance, a validated VR simulator of the middle cranial fossa approach demonstrated significant improvements in learners’ dissection speed and procedural completeness while reducing injury to neurovascular structures [24]. Similarly, VR models for orbital surgery have improved trainees’ understanding of complex anatomy and surgical planning [25].

VR has also been successfully applied to infection control training, particularly for donning and doffing personal protective equipment (PPE). An RCT comparing VR-based training with a conventional e-learning module revealed that participants in the VR group demonstrated better adherence to PPE protocols, greater confidence, and higher perceived preparedness [26]. Furthermore, VR has been used to reduce pain and anxiety in pediatric otolaryngology patients, highlighting its broader potential to support nursing practices that enhance patient comfort and cooperation [27,28].

Despite these encouraging findings, most current VR applications in nursing education are limited to basic or semi-immersive simulations. More fully immersive VR platforms capable of evaluating higher-order educational outcomes (eg, long-term knowledge retention, skill transfer to clinical practice, and clinical decision-making) are still needed [29].

Teamwork and Communication Skills Development

The development of teamwork and interprofessional communication skills is essential for otolaryngology nurses because patient care requires close collaboration among nurses, physicians, anesthesiologists, and other healthcare professionals. VR provides an effective platform for teamwork and communication training by enabling multi-user virtual simulations of clinical environments, such as emergency departments and operating rooms. Participants assume different professional roles and collaboratively manage complex clinical scenarios, thus enhancing interprofessional communication, teamwork, leadership, and resource management skills [11,30,31].

Compared with conventional simulation centers, VR-based team training offers advantages by reducing scheduling constraints, minimizing space requirements, and expanding the variety of clinical scenarios that can be practiced. It also supports remote participation; asynchronous learning; and scalable, repetitive practice of teamwork under high-pressure conditions [30,31]. These capabilities are particularly valuable for otolaryngology emergencies (eg, airway obstruction and severe hemorrhage) in which effective teamwork is critical for optimal patient outcomes.

Immersive VR further enhances realism by exposing learners to authentic clinical stressors and communication challenges, thereby promoting situational awareness, confidence, assertiveness, and conflict resolution in a safe learning environment [30]. VR systems also can incorporate performance metrics and structured debriefing tools to facilitate objective assessment of communication effectiveness and team coordination [32].

Although direct evidence for VR-based team training in otolaryngology nursing remains limited, findings from other healthcare and professional fields support its effectiveness. For example, VR has been successfully used in police training to improve de-escalation skills and stress management [30]. In pediatric otolaryngology, VR-based onboarding modules for advanced practice providers facilitate structured, stepwise competency development [31]. VR simulations can also incorporate standardized communication frameworks, such as SBAR [Situation, Background, Assessment, Recommendation], which have been associated with improved nursing communication and patient outcomes [32].

Section Summary: Current Evidence and Research Gaps

VR-based simulation has proven beneficial for developing high-risk procedural skills, such as emergency response and PPE donning and doffing, in a safe educational environment [11,24,26]. A summary of the current evidence and remaining research gaps is presented in Table 4. Evidence from small- to moderate-sized cohort studies (generally 20–60 participants) with immediate post-intervention assessments suggests improvements in technical performance and learner confidence. However, evidence concerning the transfer of these skills to clinical practice or their long-term retention remains limited [29]. Similarly, evidence supporting teamwork and communication training is largely extrapolated from related disciplines, with little direct evidence from otolaryngology nursing. Additional limitations include reliance on basic or semi-immersive technologies, the absence of studies evaluating skill transfer to real-world clinical practice, and a lack of cost-effectiveness analyses. Future research should focus on developing fully immersive, multi-user VR platforms with integrated performance analytics and evaluating their effectiveness using rigorous experimental study designs [11,29].

Table 4.

Summary of evidence for virtual reality in nursing education and skills training.

Aspect	Key findings	Evidence level	Major limitations
High-risk procedural skills	Improved technical performance, learner confidence, and adherence to PPE protocols	Moderate (small RCTs and cohort studies)	Lack of evidence for skill transfer to clinical practice; no cost-effectiveness studies
Teamwork and communication	Enhanced interprofessional collaboration (primarily inferred)	Low (indirect evidence from other disciplines)	No direct evidence in otolaryngology nursing

Note: PPE, personal protective equipment; RCT, randomized controlled trial.

The current evidence base primarily consists of simulation studies, pre-post observational studies, and a small number of RCTs. Sample sizes are generally modest (20–60 participants), and follow-up assessments are uncommon, leaving long-term skill retention and clinical applicability largely unknown. Control groups typically receive conventional instruction, e-learning, or no intervention. The most consistent findings are improvements in technical skills, such as PPE handling and procedural sequencing, along with increased self-reported confidence. Direct evidence regarding teamwork and communication in otolaryngology nursing remains scarce, and much of the supportive evidence is inferred from other healthcare disciplines. Furthermore, many studies do not clearly distinguish between feasibility and clinical effectiveness [29,30].

Future studies should comprise RCTs with long-term follow-up (≥ 6 months) to evaluate skill retention, transfer to clinical practice, and cost-effectiveness compared with conventional simulation-based training.

Exploration of VR Technology in Hearing Rehabilitation and Tinnitus Management (Patient-Facing)

Auditory Scene Training and Hearing Aid Adaptation

VR technology has received increasing attention in auditory rehabilitation and offers substantial benefits for individuals using hearing aids and cochlear implants [33–35]. A core application is the creation of realistic virtual environments with complex background noise, such as busy restaurants and urban traffic settings. These immersive environments enable targeted auditory recognition and speech comprehension training that closely reflects the challenges of everyday listening. By providing realistic and controllable auditory stimulation, VR facilitates neural adaptation and central integration of newly acquired auditory signals [33,34].

The unique advantage of VR environments lies in their precise control of acoustic parameters (eg, sound direction, distance, and signal-to-noise ratio), providing standardized and reproducible training conditions that are often difficult to achieve with conventional rehabilitation approaches [35,36]. RCTs and cohort studies involving 20 to 80 participants with follow-up periods of 1 to 6 months have shown that VR-based auditory rehabilitation using calibrated signal-to-noise ratios in simulated everyday listening environments can substantially improve speech recognition and auditory processing in hearing aid and cochlear implant users [33–35]. Parameters such as optimal training dose, appropriate environmental complexity, and applicability to unilateral versus bilateral hearing loss remain undetermined [36].

Auditory training combined with hearing aid use has been associated with improvements in cortical auditory evoked potentials, suggesting enhanced central auditory processing [33]. An example is the combination of hearing aid frequency-lowering algorithms with phoneme-based auditory training, which can improve speech perception by helping users relearn frequency-lowered speech sounds and reduce confusion associated with frequency lowering [34]. Incorporation of VR into auditory rehabilitation programs also enables individualized training that adapts to each patient’s progress. This approach is exemplified by intelligent tutorials integrated into game-based auditory training programs for cochlear implant users [35].

VR can create challenging listening environments with consistent auditory conditions, allowing users to train selective attention and improve speech perception in noisy settings. These environments can be tailored based on hearing profile, including unilateral and bilateral hearing loss. For individuals with bilateral hearing loss, VR has the potential to facilitate binaural auditory rehabilitation; those with unilateral hearing loss may benefit from targeted listening exercises [36].

VR Sound Therapy and Cognitive Behavioral Interventions for Tinnitus

Conventional tinnitus management has largely focused on sound therapy and cognitive behavioral therapy (CBT) to reduce the distress associated with phantom auditory perceptions. VR offers new opportunities to enhance these therapeutic approaches by providing immersive multisensory treatment experiences. VR-based sound therapy builds on the principles of tinnitus retraining therapy through delivery of customized virtual sound environments, such as running water or birdsong, that help mask tinnitus and redirect attention away from phantom sounds. The combination of calming auditory stimuli and immersive visual environments promotes relaxation, enhances masking effects, and may reduce tinnitus severity and its functional impact [37].

Preliminary RCTs involving 30 to 60 patients with follow-up periods of 4 to 12 weeks have shown significant improvements in tinnitus loudness and functional outcomes when VR is combined with sound therapy—relative to sound therapy alone—in selected adult populations. However, such findings have not been validated in large multicenter studies, and long-term outcomes beyond 6 months are unknown [37].

VR platforms can also incorporate CBT techniques through interactive storylines and virtual therapists. This immersive approach helps patients identify and restructure maladaptive thought patterns (eg, catastrophizing) within a supportive and safe virtual environment. The interactive nature of VR provides immediate feedback and allows therapy to be tailored to individual needs, thus improving engagement and treatment adherence. VR-based CBT can also simulate social and stressful situations, enabling patients to practice coping strategies and attentional redirection. Although research on VR-enhanced CBT for tinnitus remains in early stages, preliminary findings suggest considerable potential for improving cognitive restructuring and emotional regulation [37].

Section Summary: Current Evidence and Research Gaps

Controlled studies provide moderate evidence that VR-based auditory scene training improves speech perception in noisy environments among hearing aid and cochlear implant users [33,34]. A summary of the current evidence and remaining research gaps is presented in Table 5. For tinnitus management, preliminary RCTs suggest that combining VR with sound therapy and CBT produces better outcomes than sound therapy alone [37]. However, critical knowledge gaps remain regarding long-term durability of treatment effects, optimization of training parameters (including session frequency, treatment intensity, and environmental complexity), and generalizability across heterogeneous patient populations (eg, unilateral versus bilateral hearing loss). Future research should investigate the integration of wearable biosensors into home-based VR rehabilitation programs and develop VR-enhanced CBT interventions tailored to specific tinnitus subtypes [36,37].

Table 5.

Summary of evidence for virtual reality in hearing rehabilitation and tinnitus management.

Aspect	Key findings	Evidence level	Major limitations
Auditory scene training	Improved speech perception in noisy environments	Moderate (small RCTs and cohort studies)	Optimal training dose remains unclear; limited evidence for unilateral versus bilateral hearing loss
Tinnitus: sound therapy + CBT	Reduced tinnitus loudness and improved functional outcomes	Low to preliminary (small phase I RCTs)	Small sample sizes (30–60 participants), short follow-up (4–12 weeks), high dropout rates, lack of masking

Note: CBT, cognitive behavioral therapy; RCT, randomized controlled trial.

The current evidence for auditory scene training is primarily derived from small RCTs and cohort studies involving 20 to 80 participants with follow-up periods of 1 to 6 months. For tinnitus, relatively few early-phase RCTs (n = 30–60) have compared VR combined with sound therapy versus sound therapy alone, using follow-up periods of 4 to 12 weeks. Limitations include small sample sizes, lack of participant masking, high dropout rates, and considerable variability in outcome measures (eg, tinnitus loudness, Tinnitus Handicap Inventory, and Visual Analog Scale). The most consistent finding is improved speech perception in noisy environments among hearing aid users. Although the additional benefit of VR for tinnitus management is promising, independent replication is required. Evidence regarding patients with unilateral versus bilateral hearing loss and pediatric populations remains limited. Furthermore, many studies have used non-immersive or semi-immersive VR systems, limiting comparisons across studies and generalizability to fully immersive platforms [33–37].

Future studies should determine optimal training parameters (eg, signal-to-noise ratio, session frequency and duration, and environmental complexity) and conduct large, masked RCTs with longer follow-up periods (≥ 6 months) for tinnitus management. The integration of wearable biosensors into home-based auditory rehabilitation programs also warrants further investigation.

Current Challenges and Limitations in the Application of VR Technology in Otolaryngology Nursing

Technical Hardware and Cost Barriers

The implementation of VR in otolaryngology nursing faces important technical and financial barriers. High-quality VR headsets, specialized simulation software, and high-performance computing systems are costly and limit widespread adoption, particularly in primary care settings and resource-limited healthcare environments [38]. These challenges are compounded by the ongoing costs of upgrading hardware to maintain compatibility with evolving software and system requirements. Additionally, many current VR devices have ergonomic limitations, including excessive weight and heat generation during prolonged use, which can contribute to visual fatigue and motion sickness, thus reducing user comfort and limiting effective session duration [38]. Other technical challenges include the need for high-performance computing hardware to support seamless immersive VR experiences, which may not be available in all clinical settings. Collectively, these barriers highlight the need for more affordable, lightweight, and user-friendly VR technologies [38].

Lack of Clinical Evidence and Standardized Protocols

Despite encouraging preliminary findings, there remains a lack of robust clinical evidence and standardized intervention protocols. Most VR applications in otolaryngology nursing are still in the pilot or exploratory stage; few large-scale, multicenter RCTs have evaluated their long-term effectiveness or cost-effectiveness [38,39]. This lack of high-quality evidence hinders the ability to draw definitive conclusions regarding the long-term impact of VR on patient outcomes and nursing practice. Additionally, the absence of standardized VR protocols for specific otolaryngologic conditions has led to considerable variability in intervention content, quality, and treatment approaches [39], making it difficult to compare study findings and establish evidence-based clinical practice standards.

Additional barriers include the lack of validated clinical guidelines and reimbursement policies, which limit adoption because healthcare providers and institutions may be reluctant to integrate VR into established models of care [39]. Future clinical trials should demonstrate clinical effectiveness while establishing standardized, evidence-based VR intervention frameworks that can be consistently implemented across diverse clinical settings [38,39].

Patient Suitability and Ethical Considerations

Careful consideration of patient suitability and ethical issues is essential when implementing VR in otolaryngology nursing. VR interventions are not appropriate for all patients. Individuals with acute vestibular disorders (eg, severe vertigo), a history of epilepsy, substantial cognitive impairment, or advanced age may have difficulty tolerating VR due to the potential exacerbation of dizziness, nausea, or confusion [40]. Moreover, VR systems often collect sensitive health and behavioral data, raising important privacy and security concerns that require robust data protection measures [41].

Ethical considerations also include obtaining informed consent and ensuring that patients understand the potential risks and benefits of VR interventions. The psychological effects of immersive VR may be particularly important in vulnerable populations, such as older adults and individuals with cognitive impairment, making appropriate safeguards essential to minimize adverse outcomes (eg, increased anxiety and disorientation) [42]. Therefore, careful patient selection, strict adherence to ethical principles, and comprehensive data security measures should be prioritized. A summary of these challenges and considerations is provided in Table 6 [40–42].

Table 6.

Summary of current challenges and limitations.

Category	Specific challenges	Potential solutions
Hardware and cost	High costs, ergonomic limitations, and need for high-performance computing	Develop more affordable, lightweight, and user-friendly devices
Evidence and protocols	Lack of large RCTs, heterogeneous intervention protocols, and absence of clinical guidelines	Conduct multicenter RCTs and establish standardized protocols
Patient suitability	Contraindications (eg, severe vertigo, epilepsy, and cognitive impairment)	Careful patient screening and personalized adaptation of VR interventions
Ethics and data security	Collection of sensitive data, informed consent, and potential psychological risks	Implement robust data protection measures and standardized ethical guidelines

Note: RCT, randomized controlled trial; VR, virtual reality.

Future Research Directions

From Isolated VR Applications to Convergent Intelligent Ecosystems

The primary direction for future research is the integration of VR with complementary technologies. Early studies are investigating artificial intelligence (AI)-enhanced adaptive VR rehabilitation, in which machine learning algorithms continuously adjust task difficulty based on patients’ real-time performance data [43]. Integration of wearable inertial sensors into VR environments enables continuous home monitoring of balance and swallowing function, overcoming the limitations of intermittent clinic-based assessments [44]. Furthermore, tele-VR platforms are beginning to leverage 5G technology to support the remote delivery of tinnitus retraining therapy and vestibular rehabilitation exercises. These synergistic approaches have the potential to enhance personalization, expand access to care, and improve cost-effectiveness [43,44].

Integration of Technologies and Intelligent Development

Future developments are expected to involve deeper integration of VR with advanced technologies, including augmented reality (AR), mixed reality, brain-computer interfaces, and AI [45,46]. AR can overlay precise anatomical guidance onto the patient’s body during nursing procedures, improving procedural accuracy and safety [45]. AI can analyze patient performance data generated during VR training and adjust task complexity and content in real time, enabling personalized rehabilitation [43,46]. Brain-computer interfaces allow patients to interact with virtual environments through brain signals, offering potential benefits for individuals with severe motor impairments [46]. Combined with advances in AI-based pattern recognition, these technologies can support continuous performance feedback and dynamic updates to individualized care plans. As integrated systems continue to evolve, they may become intelligent clinical platforms capable of interpreting complex clinical information and facilitating multidisciplinary collaboration [45–47].

Expansion of Remote Nursing and Home Rehabilitation

The availability of lightweight, portable VR devices is driving expansion of remote nursing interventions and home-based rehabilitation programs. Patients can participate in vestibular rehabilitation, swallowing therapy, and psychological interventions from home while being monitored remotely. This model addresses barriers related to limited mobility, geographic distance, and constrained healthcare resources. Remote monitoring technologies (eg, wearable sensors and VR devices) provide real-time physiological and behavioral data to support individualized care. Evidence from related fields, such as pulmonary and cardiac rehabilitation, supports telerehabilitation effectiveness for improving functional outcomes, pain management, and patient satisfaction [48–50]. VR integration into telemedicine platforms enables interactive, immersive therapy sessions, reduces the need for in-person visits during situations such as infectious disease outbreaks, and extends access to specialized care for underserved and geographically isolated populations [51–53].

Realization of Personalized and Precision Nursing Care

Integration of patient-specific multi-omics, phenotypic, and real-time physiological data into VR applications is creating new opportunities for personalized and precision nursing care. By incorporating genomic, transcriptomic, proteomic, metabolomic, and biometric data (eg, heart rate variability and eye-tracking), VR-based interventions can be tailored to patient characteristics with greater precision [54,55]. Advanced AI and machine learning algorithms enable intelligent VR systems that adapt to a patient’s condition and rehabilitation progress. For example, VR visual stimuli can be adjusted via eye-tracking data to optimize cognitive engagement. Precision nursing has the potential to improve therapeutic effectiveness and patient safety by minimizing adverse events and optimizing both the timing and delivery of interventions [55,56].

Implementation of precision nursing will require nurses to develop new competencies, including expertise in biomedical informatics, ethics of precision medicine, and participatory healthcare [54–56]. This evolution aligns with the principles of value-based healthcare, emphasizing personalized, data-driven, patient-centered care. Ultimately, VR integration with precision nursing approaches has the potential to improve the quality, efficiency, and outcomes of otolaryngology nursing. A summary of future research directions is presented in Table 7 [54,55].

Table 7.

Summary of future prospects and research priorities.

Direction	Key technologies	Expected impact
Convergent intelligent ecosystems	AI, wearable sensors, and 5G-enabled tele-VR	Greater personalization, expanded remote access, and improved cost-effectiveness
Technology integration	AR, MR, and BCI	Enhanced sensory and cognitive support, improved neurorehabilitation
Remote and home-based rehabilitation	Portable VR devices and telemedicine platforms	Improved access to care and reduced need for hospital visits
Precision nursing	Multi-omics, AI, and real-time biometric monitoring	Individualized interventions and improved clinical outcomes

Note: AI, artificial intelligence; AR, augmented reality; BCI, brain-computer interface; MR, mixed reality.

Conclusions

Implementation of VR technology in otolaryngology nursing has the potential to transform patient care, rehabilitation, and nursing education. Current evidence supports VR applications in patient education, pain and anxiety management, vestibular rehabilitation, dysphagia rehabilitation, hearing rehabilitation, tinnitus management, and nursing skills training. However, supporting evidence strength considerably varies, with moderate- to high-quality evidence for vestibular rehabilitation, moderate-quality evidence for preoperative education and nursing education, and only preliminary evidence for swallowing rehabilitation and tinnitus management [1,4,12,22,37].

Despite considerable promise, widespread implementation of VR faces important challenges. Financial constraints remain a major barrier, particularly in resource-limited healthcare settings; hardware comfort, usability, and accessibility require further improvement. The current evidence base also lacks large, high-quality clinical trials needed to establish effectiveness and inform evidence-based clinical practice. Notably, the absence of standardized intervention protocols limits translation of research findings into routine clinical care [39].

Looking ahead, integration of VR with technologies such as AR and AI is expected to enable increasingly intelligent, personalized, and patient-centered models of otolaryngology nursing. Expansion of VR applications to remote and home-based care may improve access to specialized services, reduce healthcare system burden, and enhance patient engagement beyond conventional clinical settings [51,52].

Future research should prioritize generation of rigorous clinical evidence through well-designed RCTs and longitudinal studies, as well as the development of cost-effective, user-friendly VR technologies, ethical implementation frameworks, and robust data security policies. Collaboration among healthcare providers, engineers, ethicists, and policymakers will be essential to establish standardized guidelines for the safe, effective, and sustainable implementation of VR in otolaryngology nursing. By addressing current limitations and fostering interdisciplinary innovation, VR may advance otolaryngology nursing toward a more intelligent, personalized, and patient-centered future.