Ergonomics in Otolaryngology: A Systematic Review and Meta‐analysis

Abstract

Objectives To determine the proportion of otolaryngologists with work‐related musculoskeletal discomfort (WRMD) and to review objective ergonomic data that contribute to WRMD. Study Design Systematic review and meta‐analysis. Methods A comprehensive search of the literature identified 1121 articles for initial review of which 19 (3563 participants) met criteria for qualitative discussion and eight (2192 participants) met criteria for meta‐analysis. Random effects meta‐analyses were used to estimate the proportion of otolaryngologists reporting WRMD. Results The overall proportion (95% confidence intervals [CI]) of general otolaryngologists reporting WRMD was 0.79 (0.66, 0.88) for any symptoms; 0.54 (0.40, 0.67) for neck symptoms; 0.33 (0.20, 0.49) for shoulder symptoms; and 0.49 (0.40, 0.59) for back symptoms. Surgeons performing primarily subspecialty cases had a lower estimated overall prevalence of WRMD versus those performing general ENT cases, however the odds ratio (OR) was not statistically significant (OR [95% confidence interval] 0.53 [0.22, 1.25]). 23%–84% of otolaryngologists underwent medical treatment for WRMD. 5%–23% took time off work and 1%–6% stopped operating completely as a result of WRMD. 23%–62.5% of otolaryngologists believed WRMD negatively impacted their quality of life. Objective measures of ergonomic posture indicate moderate to severe risk of injury during the routine clinic and surgical procedures with none found to be low risk. Conclusions Ergonomic stressors among otolaryngologists contribute to a high rate of WRMD across all subspecialties with notable impact on productivity, longevity, and quality of life. Laryngoscope, 133:467–475, 2023

Quantitative Ergonomic Comparison of Traditional Versus Endoscopic-Assisted Tonsillectomies: A Prospective Case-Control Study

“…This study demonstrated that 37% of intraoperative observations had a high ergonomic risk, while 16% had a very high risk (2). Furthermore, a recent systematic review and meta-analysis demonstrated the prevalence of workrelated MSK discomfort to be approximately 79% among practicing otolaryngologists (5). Thus, given the high prevalence of work-related musculoskeletal discomfort and the unacceptable level of ergonomic risk for common procedures, analyzing the ergonomic risk of alternative techniques and new technologies is needed to reduce and lower the risk of musculoskeletal injury for otolaryngologists.…”

Association of Vibrotactile Biofeedback With Reduced Ergonomic Risk for Surgeons During Tonsillectomy

“…Among practicing otolaryngologists, 79% reported workrelated musculoskeletal discomfort, with more than half requiring medical treatment and 16% requiring time off work. 2 Despite the breadth of the field, nearly all subspecialties of otolaryngology are affected. Prolonged static at-risk posture has been observed in head and neck surgeons while operating.…”

“…The prevalence among surgeons of WMSDs involving the neck, shoulder, and back region has been reported to be as high as 49% to 60% . Furthermore, WMSD may be associated with stiffness, fatigue, or numbness, affecting patient safety and outcomes …”

“…2 Repetitive movements and overuse are often the source of WMSD. 2,3 Since repetitive movements and overuse are common in surgery, our previous work quantified ergonomic risk in common otolaryngologic procedures. Using a standardized instrument of workplace ergonomics, the Rapid Upper Limb Assessment (RULA), we found that adenotonsillectomy and tympanostomy tube insertion carried substantial ergonomic risk.…”

“…1 Furthermore, WMSD may be associated with stiffness, fatigue, or numbness, affecting patient safety and outcomes. 2 Repetitive movements and overuse are often the source of WMSD. 2,3 Since repetitive movements and overuse are common in surgery, our previous work quantified ergonomic risk in common otolaryngologic procedures.…”