Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery

Abstract

Objective To determine whether surgeon use of a soft cervical collar during endoscopic and microscopic otologic surgery is feasible and impacts surgeon ergonomics as measured by inertial sensors. Study Design Prospective crossover trial. Setting US-based otolaryngology training program. Patients Otolaryngology residents and fellows. Interventions Therapeutic—use of a soft cervical collar during simulated otologic surgery. Main Outcome Measures Time spent in high-risk angles of neck and back flexion and extension; average angle of neck flexion, extension, rotation, and lateral bending; validated assessment of neck pain; average daily phone use. Results Fifteen subjects met criteria for inclusion. Ten of 15 (67%) were male. Seven of 15 (47%) were postgraduate year 1–2. Seven of 15 (47%) reported a history of neck pain. None reported prior spinal steroid injections or surgery. Across all subjects, use of the soft cervical collar significantly reduced time spent in high-risk angles of neck flexion/extension during both endoscopic (56% vs. 35%, p < 0.05) and microscopic (60% vs. 32%, p < 0.05) otologic surgery. There was no effect on back flexion or extension. There was no difference in time spent in high-risk neck or back angles between endoscopic and microscopic surgery. Average angles of neck or back flexion, extension, lateral bending, and rotation were not significantly different for subgroups with more operative experience, increased phone use, perception of good posture, or history of neck pain. Conclusions Use of a soft cervical collar during simulated otologic surgery significantly reduced time spent in high-risk neck positions. These data support feasibility of soft collar use during otologic surgery and hold promise for reduction in the high rates of neck pain reported by neurotologists. Professional Practice Gap and Educational Need Improving surgeon ergonomics for otologic surgery. Learning Objective To identify a therapeutic intervention to mitigate neck pain in surgeons caused by assumption of high-risk cervical neck flexion and extension. Desired Result To demonstrate that use of a readily available soft cervical collar reduces risk of neck pain in otologic surgeons. Level of Evidence II. Indicate IRB or IACUC Exempt.