Research studies have shown that some 50-76% of otolaryngologists report musculoskeletal pain — most often, neck pain — at some point over the course of an average year, says Johns Hopkins neurotologist and lateral skull base surgeon Deepa Galaiya. As such, Galaiya, wellness director for the Department of Otolaryngology–Head and Neck Surgery, has been investigating contributors to pain related to performing surgeries, and how improving ergonomics in the operating room can keep surgeons at the top of their game.

One recent report examined how seated posture could contribute to muscle fatigue during surgical drilling. Thirteen head and neck surgeons and surgical trainees from Johns Hopkins wore sensors measuring muscle activity while they used a surgical drill to remove the top of a raw eggshell without cracking it, as a simulation for ear surgery. They performed the task three times in randomly assigned positions: Neutral, where the knees and elbows were at 90-degree angles; slouched, where the operating table and seat were lowered and a microscope was slightly below the surgeon’s eyeline; and craned, where the operating table and seat were raised and the microscope was slightly above the surgeon’s eyeline.

The wrist muscle and upper trapezius — a triangular muscle in the back connecting the neck and shoulders — were the ones that experienced the most fatigue regardless of surgical position, Galaiya says. However, there was significantly more fatigue in the trapezius when surgeons were slouched. Additionally, female surgeons experienced more fatigue than males, possibly due to the weight of the drill, she says. These results were published in Otolaryngology-Head and Neck Surgery.

“Most of the research in ergonomics across multiple surgical fields has been dependent on survey studies and anecdotal evidence,” says Galaiya. “This is a method of trying to quantify what’s really happening,” which can identify risk factors and help experts develop effective interventions.

Additional studies of hers demonstrated that both endoscopic and microscopic approaches in otologic surgery are associated with high-risk neck angles, which can result in sustained neck strain. And, a study on operating room chairs and tables showed that the equipment can be comfortably adjusted only for surgeons with a minimum height of 5’ 6”.

To best reduce fatigue, Galaiya advises, surgeons should ensure that all limbs are in 90-degree angles and neutral positions, especially the neck. “The neck being craned or the back being slouched are both really bad positions long term for degenerative disc disease.”

Surgeons can also benefit from using a support under the arm to keep hands steady and reduce upper arm exertion when moving instruments.

“I tell residents that they don’t want their shoulder or biceps to do any work while they operate, and all the work should be limited to the wrists and fingers – meaning they can be ‘lazy’ and lean against a support,” she says. “That’s what’s going to let you operate for a long period of time without fatigue.”

To refer a patient or make an appointment in the Department of Otolaryngology–Head and Neck Surgery, call 443-997-6467.