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Scientific Oral Presentations

Otology/Neurotology

Session: Scientific Oral Presentation 8 - Otology/Neurotology

Effects of Wrist Support and Posture on Fatigue and Cognitive Load in Simulated Otologic Surgery

Tuesday, October 14, 2025
11:36 AM - 11:42 AM EDT
Location: 239
Disclosure(s):
Sarah Gao, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Deepa J. Galaiya, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Otolaryngologists are at high risk for work-related musculoskeletal disorders, particularly due to poor positioning during microsurgery. This study examines the effects of wrist support and posture on muscle fatigue and cognitive load in otologic surgery using surface electromyography (sEMG) and inertial measurement units (IMU) in a drilling simulation exercise.

Methods: In a randomized crossover trial (12 total trials), six otolaryngology trainees drilled 3D printed phantom temporal bones with and without wrist support while wearing sEMG sensors on the upper trapezius, anterior deltoid, biceps, and extensor carpi radialis (ECR) of the dominant arm and IMUs on the upper back and posterior scalp. Muscle fatigue and neck angles were derived from sEMG and IMU measurements, respectively, and subsequently correlated with survey responses, including the NASA Task Load Index, a validated measure of cognitive load.

Results: Using an elevated wrist rest for support significantly reduced temporal demand (p = 0.039) and overall workload (p = 0.031) while improving self-reported ergonomics ratings (p = 0.046). ECR fatigue was more likely with smaller glove size (OR = 4.778, p < 0.001) and increased operating hours per week (OR = 3.162, p = 0.040). Notably, participants with biceps fatigue rated their positioning in the trial as less representative of their typical surgical posture (U = 4.0, p = 0.023). Additionally, participants spent 59.3-100% of trials in high-risk neck angles, with greater flexion linked to higher frustration (p = 0.047).

Conclusions: This study highlights a first step in quantifying the relationship between wrist support, fatigue, and workload in otologic surgery. Results suggest that absent wrist support, along with increased neck flexion, unfamiliar positioning, and individual participant factors, may significantly contribute to greater muscle fatigue and cognitive demand. These findings build on previous ergonomic analyses of operating postures, reinforcing the need for formal ergonomics training in otolaryngology programs.

    Presenting Author(s)

  • SG

    Sarah Gao, BA

    Medical Student
    Johns Hopkins University School of Medicine
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Ahjeetha Shankar, BS

    Medical Student
    Johns Hopkins University School of Medicine
    Baltimore, MD, United States

    Disclosure information not submitted.

  • OW

    Oren Wei, BS

    Medical Student
    Johns Hopkins University School of Medicine
    Baltimore, MD, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Deepa J. Galaiya, MD

    Assistant Professor of Otolaryngology - Head and Neck Surgery
    Johns Hopkins - Dept of OTO - HNS
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.