(844) Ergonomics in Endoscopic Ear Surgery: A Systematic Review

Introduction: Otologic surgeons have high rates of neck and upper extremity musculoskeletal strain due to microscope dependent head flexion. Endoscopic ear surgery allows for screen-based, heads-up visualization; this study seeks to provide an updated synthesis of current literature on ergonomics in endoscopic ear surgery (EES).

Methods: The PubMed, Medline, Embase, and Scopus Databases were searched for clinical studies, in English, relating to ergonomics in endoscopic ear surgery. Article information, level of evidence, and summaries of findings were extracted.

Results: Thirteen studies were identified for inclusion from March 2017 to July 2024. Five articles were level 2 (38%), with the majority level 5 (54%), and one level 4 (8%). Among the five studies providing quantitative data, most showed that surgeons performing microscopic surgery had significantly worse flexion of the neck and back compared to EES, with one study showing no difference. Higher levels of pain after microscopic surgery by attendings were also noted. EES was comparable in physical demand to robotic surgery in one study, and resulted in a worse overall rapid upper limb assessment score compared to exoscope use in another. Narrative articles reported improved posture and decreased static neck loading with EES. Recommendations from narrative articles included utilization of armrests and basic ergonomic principles, placement of video towers directly across from the surgeon at eye level, and stabilization of the endoscope by resting on the patient’s cartilaginous meatus.

Conclusions: Recent moderate-quality evidence demonstrates improved ergonomics with EES compared to traditional microscopy, though high-quality quantitative studies remain sparse. By enabling heads-up visualization and neutral cervical posture, EES may reduce musculoskeletal injury risk. Additional studies are needed to understand the ergonomic differences of EES compared to exoscopic or robotic surgery. Basic ergonomic principles remain crucial for surgeon health and longevity, regardless of modality.