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Optimizing Positioning for In-Office Otology Procedures.
Otolaryngol Head Neck Surg. 2017 01; 156(1):156-160.OH

Abstract

Objective Surgeons often report musculoskeletal discomfort in relation to their practice, but few understand optimal ergonomic positioning. This study aims to determine which patient position-sitting versus supine-is ergonomically optimal for performing otologic procedures. Study Design Observational study. Setting Outpatient otolaryngology clinic setting in a tertiary care facility. Subjects and Methods We observed 3 neurotologists performing a standardized simulated cerumen debridement procedure on volunteers in 2 positions: sitting and supine. The Rapid Upper Limb Assessment (RULA)-a validated tool that calculates stress placed on the upper limb during a task-was used to evaluate ergonomic positioning. Scores on this instrument range from 1 to 7, with a score of 1 to 2 indicating negligible risk of developing posture-related injury. The risk of musculoskeletal disorders increases as the RULA score increases. Results In nearly every trial, RULA scores were lower when the simulated patient was placed in the supine position. When examined as a group, the median RULA scores were 5 with the patient sitting and 3 with the patient in the supine position (P < .0001). When the RULA scores of the 3 neurotologists were examined individually, each had a statistically significant decrease in score with the patient in the supine position. Conclusion This study indicates that patient position may contribute to ergonomic stress placed on the otolaryngologist's upper limb during in-office otologic procedures. Otolaryngologists should consider performing otologic procedures with the patient in the supine position to decrease their own risk of developing upper-limb musculoskeletal disorders.

Authors+Show Affiliations

1 Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA.2 Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA.1 Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA. 2 Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA.1 Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA. 2 Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, USA.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27650804

Citation

Govil, Nandini, et al. "Optimizing Positioning for In-Office Otology Procedures." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 156, no. 1, 2017, pp. 156-160.
Govil N, DeMayo WM, Hirsch BE, et al. Optimizing Positioning for In-Office Otology Procedures. Otolaryngol Head Neck Surg. 2017;156(1):156-160.
Govil, N., DeMayo, W. M., Hirsch, B. E., & McCall, A. A. (2017). Optimizing Positioning for In-Office Otology Procedures. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(1), 156-160. https://doi.org/10.1177/0194599816670137
Govil N, et al. Optimizing Positioning for In-Office Otology Procedures. Otolaryngol Head Neck Surg. 2017;156(1):156-160. PubMed PMID: 27650804.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing Positioning for In-Office Otology Procedures. AU - Govil,Nandini, AU - DeMayo,William M, AU - Hirsch,Barry E, AU - McCall,Andrew A, Y1 - 2016/10/03/ PY - 2016/9/22/pubmed PY - 2017/7/28/medline PY - 2016/9/22/entrez KW - cerumen removal KW - ergonomics KW - musculoskeletal pain KW - otologic surgery SP - 156 EP - 160 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 156 IS - 1 N2 - Objective Surgeons often report musculoskeletal discomfort in relation to their practice, but few understand optimal ergonomic positioning. This study aims to determine which patient position-sitting versus supine-is ergonomically optimal for performing otologic procedures. Study Design Observational study. Setting Outpatient otolaryngology clinic setting in a tertiary care facility. Subjects and Methods We observed 3 neurotologists performing a standardized simulated cerumen debridement procedure on volunteers in 2 positions: sitting and supine. The Rapid Upper Limb Assessment (RULA)-a validated tool that calculates stress placed on the upper limb during a task-was used to evaluate ergonomic positioning. Scores on this instrument range from 1 to 7, with a score of 1 to 2 indicating negligible risk of developing posture-related injury. The risk of musculoskeletal disorders increases as the RULA score increases. Results In nearly every trial, RULA scores were lower when the simulated patient was placed in the supine position. When examined as a group, the median RULA scores were 5 with the patient sitting and 3 with the patient in the supine position (P < .0001). When the RULA scores of the 3 neurotologists were examined individually, each had a statistically significant decrease in score with the patient in the supine position. Conclusion This study indicates that patient position may contribute to ergonomic stress placed on the otolaryngologist's upper limb during in-office otologic procedures. Otolaryngologists should consider performing otologic procedures with the patient in the supine position to decrease their own risk of developing upper-limb musculoskeletal disorders. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/27650804/Optimizing_Positioning_for_In_Office_Otology_Procedures_ DB - PRIME DP - Unbound Medicine ER -