The Ergonomics of Endoscopic Ear Surgery: An International Survey

OBJECTIVE: To investigate the global prevalence, contributing factors and impact of work-related musculoskeletal disorders (WRMD), and ergonomics interventions and education, among otolaryngologists who perform endoscopic ear surgery (EES). STUDY DESIGN: Cross-sectional survey. METHODS: A 58-item electronic survey was distributed between September 2024 and May 2025. Data were collected regarding demographics, health and lifestyle, professional training, surgical practices, WRMD, ergonomics training, and interventions. RESULTS: There were 204 respondents from 49 countries who met inclusion criteria. For the 111 respondents (54.4%) performing EES <50% of the time and 93 (45.6%) performing EES >50% of the time, there was a lifetime prevalence of WRMD of 70.3% and 76.3% (P=0.330), 12-month prevalence of 58.6% and 65.6% (P=0.303), and 7-day prevalence of 35.1% and 40.9% (P=0.401), respectively. Respondents performing >50% EES were significantly more likely to perceive differences in WRMD when using an endoscope compared with a microscope (45.2% vs. 30.6%, P=0.033). They were also more likely to report a higher median severity of WRMD in the left chest/thoracic spine (1 [IQR: 0 to 3] vs. 2.5 [IQR: 1 to 6], P=0.035) and left lumbosacral spine (3 [IQR: 2 to 5] vs. 5 [IQR: 2 to 6.25], P=0.012). The median score for ergonomic comfort was significantly lower (7 [IQR: 6 to 8] vs. 6 [IQR: 5 to 8], P=0.035). CONCLUSIONS: Performing a higher proportion of EES is associated with back-related WRMD and ergonomic discomfort. There is an important need to develop surgical education and implement interventions to realize the ergonomic potential of EES.