Factors Associated with High‐Risk Ergonomic Postures During Office‐ Based Rhinology Procedures: A Pilot Biomechanical Analyses

CLINICAL QUESTION

What ergonomic risks do rhinologists face during common office-based procedures, and how does procedure type influence the frequency of high-risk postures?

BOTTOM LINE

Rhinologists spend a significant proportion of office procedure time in high-risk ergonomic postures, especially during neck rotation and shoulder movements. The type of procedure influences the extent of ergonomic risk, highlighting the need for targeted ergonomic interventions.

BACKGROUND: Work-related musculoskeletal disorders are highly prevalent among otolaryngologists, especially those performing endoscopic procedures. Despite high symptom burden, ergonomic awareness and practice remain limited. Understanding the biomechanical strain during routine office-based rhinology procedures is critical to protecting clinicians’ well-being and sustaining procedural performance.

STUDY DESIGN: A pilot biomechanical study using inertial measurement units (IMUs, or wearables) to quantify lower back, neck, and shoulder range of motion during office rhinology procedures.

SETTING: Multicenter academic hospital system (Mount Sinai Health System, New York), involving two fellowship-trained rhinologists

SYNOPSIS: This study evaluated 64 office-based procedures—28 nasal endoscopies, 19 rhinitis procedures, and 17 turbinate reductions—performed by two right-handed male rhinologists. Wearable sensors were placed on key anatomical regions (frontal bone, sternum, lumbar spine, bilateral upper arms) to track kinematic data. The Rapid Upper Limb Assessment (RULA) was used to determine the proportion of time spent in high-risk ergonomic postures. Across all procedures, rhinologists spent substantial time in high-risk positions: 82.9% in neck rotation, 78.1–79.9% in shoulder flexion/ extension and rotation, and 68.5% in lower back rotation. Postural strain varied by procedure. For example, lower back rotation was most pronounced during rhinitis procedures (87.3%), while neck flexion was greatest during nasal endoscopy (54.2%). Shoulder movements also differed significantly by procedure. Right shoulder abduction/adduction, for instance, peaked during nasal endoscopy (48.7%) but was significantly lower during rhinitis (18.2%). These findings underscore how procedural characteristics—such as duration, complexity, and instrument handling—shape ergonomic demands. Notably, current clinical environments may lack sufficient ergonomic safeguards for prolonged tasks. The authors advocate for follow-up studies incorporating engineering and workflow modifications. Limitations include a small sample (n=2), potential imprecision in generalizability, and reliance on RULA thresholds, some of which are based on outdated literature.

CITATION: Liu K, et al. Factors associated with high-risk ergonomic postures during office-based rhinology procedures: a pilot biomechanical analyses. Int Forum Allergy Rhinol. 2025;15:448-450. doi:10.1002/alr.23520

COMMENT: This manuscript investigates the challenging ergonomics associated with office-based rhinology procedures. There is existing literature regarding the impact of ergonomics and posture on endoscopic sinus surgery in the OR, but this study uses a biomechanical analysis and wearable inertial measurement units to evaluate the time spent in “high-risk” positions during office procedures. They found that 97% of the time is spent in high-risk positions across the neck, shoulder, and lower back. Practitioners should be cognizant of the strain on their bodies and make a conscious effort to optimize positioning in order to improve longevity in their careers. Ashoke Khanwalkar, MD