Higher Ergonomic Risk in Female Otolaryngologists During Bedside Laryngoscopy, Independent of Physical Characteristics and Training

Introduction: Female surgeons report higher rates of musculoskeletal disorders than males, yet quantitative ergonomic data in otolaryngology remain limited. This study quantifies gender-specific postural risk during bedside laryngoscopy using motion capture technology and standardized ergonomic assessment

Methods: Seventeen otolaryngology residents and faculty (8M; 9F) performed simulated bedside laryngoscopy in December 2024. Full-body kinematics were captured using a 3D motion capture system, and modified Rapid Upper Limb Assessment (RULA) scores quantified ergonomic risk.
Gender differences were assessed using independent t-tests, followed by hierarchical Bayesian regression to estimate gender-specific effects while controlling for height, hand size, and years of experience.

Results: Female surgeons demonstrated significantly higher total modified RULA scores than males (females: 17.2 ± 2.0; males: 14.0 ± 2.3; p < 0.01). Hierarchical Bayesian analysis confirmed this gender difference (females: 16.3, 95% HDI: 14.0–18.6; males: 14.4, 95% HDI: 12.0–16.7), with posterior distributions showing separation.
After controlling for physical traits, the gender difference persisted. Height, hand size, and years of experience showed no reliable associations with ergonomic scores in either gender group (all 95% HDIs included zero), indicating that anthropometric measures and clinical experience do not explain the observed gender disparity.

Conclusions: The gender difference in ergonomic risk, not explained by physical dimensions or experience, suggests unmeasured factors such as technique, equipment design, or training quality drive the disparity. Gender-specific ergonomic interventions should focus on these modifiable factors rather than simple anthropometric accommodations.