{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:30:13Z","timestamp":1787617813467,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["OTO Open"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Evaluate ergonomic differences of various modalities for performing middle ear surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two academic tertiary care centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Attending physicians and residents performing middle ear surgery were photographed intraoperatively. Intraoperative photographs were analyzed using the validated Rapid Upper Limb Assessment (RULA) tool to measure musculoskeletal disease (MSD) risk. Descriptive statistics and significance testing were used to characterize and compare ergonomic differences between surgical modalities. Multivariable ordinal regression was performed to assess factors associated with increased MSD risk, as determined by the final RULA score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most of our 110 intraoperative photos featured attendings (82.7%) performing combined middle ear surgery and mastoidectomy (60.0%). Body angles and the final RULA score varied significantly among modalities. On subset analysis, microscopic surgery exhibited significantly worse wrist, trunk, and neck angles compared to endoscopic and exoscopic surgery. Exoscopic surgery had significantly lower final RULA scores than both endoscopic and microscopic surgery, indicating significantly lower MSD risk. Microscopic and endoscopic surgery final scores did not vary significantly. In a multivariable ordinal regression of factors associated with increased RULA score, exoscopic surgery had statistically significantly less ergonomic risk relative to microscopic surgery (odds ratio\u2009=\u20090.12, 95% confidence interval\u2009=\u2009[0.03\u20100.43]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Exoscopic, endoscopic, and microscopic surgery all featured low ergonomic risk, although exoscopic middle ear surgery demonstrated the lowest risk profile among studied surgical modalities. This demonstrates the importance of using each modality in combination with other ergonomic interventions to provide meaningful musculoskeletal benefits.<\/jats:p><\/jats:sec>","DOI":"10.1002\/oto2.162","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T04:05:05Z","timestamp":1720065905000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Ergonomics of Various Modalities for Ear Surgery"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9914-9670","authenticated-orcid":false,"given":"Matthew E.","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery David Geffen School of Medicine at University of California Los Angeles Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Caruso Department of Otolaryngology\u2013Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Kakeheta","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ota General Hospital Kawasaki Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4237-3564","authenticated-orcid":false,"given":"Tsukasa","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery Yamagata University Faculty of Medicine Yamagata Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3918-2337","authenticated-orcid":false,"given":"Seiji B.","family":"Shibata","sequence":"additional","affiliation":[{"name":"Caruso Department of Otolaryngology\u2013Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-017-4787-1"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2017.01.013"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002769"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2022.103405"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000003858"},{"key":"e_1_2_8_7_1","volume-title":"Exoscope\u2010Assisted Surgery in Otorhinolaryngology","author":"DeVirgilio A","year":"2022"},{"issue":"275","key":"e_1_2_8_8_1","first-page":"88","article-title":"Dual approach using TEES and exoscope for middle ear cholesteatoma with mastoid extension","author":"Ito T","year":"2022","journal-title":"MB ENTONI"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2019.102882"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-6870(93)90080-S"},{"key":"e_1_2_8_11_1","unstructured":"MiddlesworthM. 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