Ergonomics in Otolaryngologic Surgery: A State of the Art Review.

Abstract

Otolaryngology is a surgical field with a high degree of ergonomic risk. The use of head-mounted lighting, loupe magnification, endoscopes, and microscopes is inherent to the field, coupled with repetitive fine motor movements in a constrained anatomic field as well as static, ergonomically unfavorable postures. We seek to review the otolaryngologic literature on ergonomics, including prevalence, severity, and interventions in decreasing work-related musculoskeletal pain. Data were derived from clinical peer-reviewed primary literature as well as information provided by residency programs and presented at national and international meetings. A comprehensive review was performed by 3 independent reviewers utilizing an electronic database literature search through PubMed, Embase, and Cochrane Library. Search terms included combinations and variations of the following concepts: ergonomics, surgery, otolaryngology, work related musculoskeletal disorders, chronic cervical pain, musculoskeletal, posture, surveys, microsurgery, endoscopic surgery. Strict objective criteria for inclusion were not used due to the inherent heterogeneity in articles and lack of rigorous empirical evidence. Chronic musculoskeletal pain is prevalent among otolaryngologic surgeons, with many procedures producing high ergonomic risk. Most studies evaluating interventions to decrease ergonomic risks demonstrate promising results, but standardization in methods and outcome reporting is needed. Literature shows that musculoskeletal pain begins in training, and there is a paucity of information related to ergonomic risk in otolaryngology residency curriculums. Work-related musculoskeletal disorders related to poor workplace ergonomics have the potential to limit career longevity and lead to physician burnout. Interventions to mitigate this risk are effective and tend to be well received by physicians.