Prevalence and predictors of musculoskeletal disorders among otolaryngologists: a cross-sectional analytic study

Abstract

Background

Otolaryngologists frequently work in prolonged neck positions and perform repetitive upper-limb movements, which may increase their risk of work-related musculoskeletal disorders. Yet the prevalence and contributing factors of conditions such as lateral epicondylitis and cervical disc herniation remain insufficiently explored in this group. This study aims to determine their burden and identify associated factors among otolaryngologists.

Methods

This descriptive cross-sectional study included 129 otolaryngologists from university hospitals across Iran. Data on neck and elbow symptoms and related diagnoses were collected using a structured musculoskeletal questionnaire. Associations with demographic and occupational factors were analyzed using Chi-square tests, t-tests, and multivariable regression. A p-value < 0.05 was considered statistically significant.

Results

Among 129 otolaryngologists, neck pain was reported by 90.7%, elbow pain by 31.0%, cervical disc herniation by 11.6%, and lateral epicondylitis by 15.5%. After adjustment, elbow pain remained independently associated with older age and rhinology subspecialty. Lateral epicondylitis showed a borderline association with older age. It was also independently associated with the rhinology subspecialty. No independent associations were identified for neck pain, cervical disc herniation, or disability.

Conclusion

Musculoskeletal symptoms were common, with age ≥ 50 years and rhinology practice being independently associated with elbow pain and, rhinology practice being independently associated with lateral epicondylitis. No associations were identified for neck pain or disc herniation. Targeted ergonomic measures and further longitudinal research are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-26533-y.

Background

Work-related musculoskeletal disorders (WMSDs) are common occupational health problems among healthcare professionals and are associated with pain, functional limitation, and reduced work efficiency [1]. Certain conditions, including lateral epicondylitis, also known as tennis elbow, and cervical disc herniation, have been linked to occupations involving repetitive upper-extremity movements, awkward postures, and prolonged static neck positions [2].

Previous studies have suggested that otolaryngologists may be at increased risk of WMSDs due to the ergonomic demands of their practice, including sustained neck flexion or rotation, repetitive fine motor hand activities, and prolonged surgical procedures performed under constrained ergonomic conditions [3].

Despite growing interest in work-related musculoskeletal disorders among surgeons, data specific to otolaryngologists remain limited. To our knowledge, no study has comprehensively examined the prevalence and associated factors of lateral epicondylitis or cervical disc herniation in this specialty. In addition, pain severity and pain-related functional disability have been insufficiently evaluated in existing studies focusing on ENT surgeons [4–7]. Measuring pain severity and pain-related disability allows a more nuanced assessment of disease burden, capturing not only the presence of symptoms but also their impact on daily activities and professional performance.

Therefore, this study aimed to assess the prevalence of lateral epicondylitis and cervical disc herniation among otolaryngologists, evaluate associated pain severity and pain-related disability, and identify demographic and occupational factors associated with these conditions. By addressing these gaps, this study seeks to provide evidence to inform future ergonomic and preventive strategies in otolaryngology practice.

Methods

This is a descriptive-analytical cross-sectional study conducted among otolaryngologists practicing in academic clinical centers nationwide. Eligible participants for inclusion met the following criteria: otolaryngologists actively engaged in clinical practice in university hospitals and healthcare centers across Iran who provided informed consent. Exclusion criteria were a prior history of significant cervical, spine or elbow trauma, previous surgery or congenital anomalies in the cervical spine or elbow region. The sample size was calculated using the Cochran formula for estimating a single proportion, considering an expected prevalence of lateral epicondylitis of 20% among surgeons, a 95% confidence level, and a precision of 5%. The minimum required sample size was estimated to be 122 participants. To account for a possible 10% non-response rate, the final target sample size was increased to 130 participants. This sample size allowed adequate precision and statistical power to detect the expected prevalence. A convenience sampling method was used to recruit participants among otolaryngology surgeons working in university hospitals and healthcare centers across Iran. This sampling approach was employed due to the practical constraints of recruiting otolaryngologists across multiple academic centers nationwide and the absence of a comprehensive national registry of practicing ENT surgeons. While this approach facilitated feasibility and participation, it may introduce selection bias, and the findings should therefore be interpreted with this limitation in mind.

Data were collected using a structured questionnaire, a modified version of the Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms [8]. While the original instrument covers multiple anatomical regions and includes a body-map component, for the purposes of this study, only the items related to neck symptoms (including the demographic neck-pain section of the Nordic questionnaire) and lateral-elbow symptoms were retained, and questions addressing other anatomical regions and the body-map component were excluded. The questionnaire was supplemented with an item on surgical subspecialty, brief measures of neck and lateral-elbow pain severity (categorized as mild, moderate, or severe), and two additional items assessing prior physician-diagnosed cervical disc herniation and prior physician-diagnosed lateral epicondylitis. Pain severity was assessed using a numeric rating scale (NRS) ranging from 0 to 10, where 0 indicated no pain and 10 indicated the worst imaginable pain. Severity categories were defined as mild (scores 1–3), moderate (scores 4–6), and severe (scores 7–10). Physical activity was assessed using a self-reported questionnaire item asking participants to estimate their average weekly duration of exercise. Response options included none, < 1 hour, 1–3 hourh, 3–5 hour, and > 5 hour per week. For statistical analysis, physical activity was dichotomized as < 1 hour per week versus ≥ 1 hour per week. This approach was chosen to reduce model complexity, avoid sparse data across multiple categories, and minimize the risk of spurious statistically significant associations arising from excessive categorization, while preserving interpretability.

In this study, neck pain and lateral elbow pain were assessed as lifetime occupational symptoms. Participants were asked whether they had experienced neck or lateral elbow pain at any time during their professional practice as otolaryngologists. Pain-related disability was assessed by asking participants whether their neck or elbow pain had ever interfered with daily or occupational activities.

To assess construct validity, an exploratory factor analysis was performed using SPSS. The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was 0.667, indicating an acceptable adequacy for factor analysis. Bartlett’s test of sphericity was statistically significant (p < 0.01), confirming sufficient intercorrelations among items. Reliability was assessed using Cronbach’s alpha, which was calculated as 0.65. Although values above 0.70 are often recommended for established scales, a Cronbach’s alpha of 0.60–0.70 is generally considered acceptable in exploratory research and descriptive epidemiological studies, particularly when assessing heterogeneous constructs or abbreviated instruments. Given the exploratory nature of this study and the use of a modified questionnaire focusing on selected anatomical regions, this level of internal consistency was deemed acceptable for research purposes.

The dependent variables in this study included neck pain, lateral elbow pain, physician-diagnosed lateral epicondylitis, cervical disc herniation, pain severity, and pain-related disability. Neck pain and lateral elbow pain were defined as self-reported pain experienced at any time during the participant’s professional career as an otolaryngologist. Pain-related disability was defined as self-reported interference with daily or occupational activities attributable to neck or elbow pain. Cervical disc herniation and lateral epicondylitis were defined based on participants’ self-reported history of a prior medical diagnosis made by a physician. Participants were specifically asked whether they had ever been diagnosed with these conditions by a healthcare professional, rather than simply reporting symptoms. No independent verification through medical records or imaging was performed. These outcomes were assessed based on participants’ self-reports using standardized musculoskeletal items. Independent variables included age, sex, years of professional experience, number of surgeries performed per week, surgical subspecialty (rhinology vs. non-rhinology), and weekly physical activity level. These variables were selected to identify potential occupational and demographic factors associated with musculoskeletal disorders among otolaryngologists, based on prior literature and expert consensus. To minimize the effect of confounding variables, individuals with known chronic musculoskeletal or neurological disorders unrelated to occupational exposure were excluded. In addition, potential confounders were controlled analytically using multivariable logistic regression and ordinal regression models, depending on the outcome type.

Statistical analyses were performed using SPSS (version 27). Categorical variables were compared using the Chi-square test or Fisher’s exact test, as appropriate. Continuous variables were analyzed using independent-samples t-tests after assessment of variance homogeneity. Binary outcomes, including neck pain, lateral epicondylitis, and cervical disc herniation, were analyzed using multivariable logistic regression, while ordinal outcomes, such as pain severity, were evaluated using ordinal logistic regression. All multivariable models were adjusted for age, sex, years of professional experience, number of weekly surgeries, physical activity level, and surgical subspecialty. Age was primarily modeled as a continuous variable and additionally analyzed as a dichotomized variable (< 50 vs. ≥50 years) in secondary analyses to facilitate interpretation and assess robustness. Potential multicollinearity between age and years of professional practice was evaluated using variance inflation factors and was not found to be problematic. Effect estimates were reported as odds ratios (ORs) with 95% confidence intervals, and a two-sided p-value < 0.05 was considered statistically significant. For univariable comparisons using independent-samples t-tests, effect sizes were calculated and expressed as Cohen’s d with corresponding 95% confidence intervals. Effect-size magnitudes were interpreted according to conventional thresholds, with values of approximately 0.2 considered small, 0.5 moderate, and 0.8 large. The primary inferential analyses, however, were based on multivariable regression models, for which effect sizes were reported as odds ratios with 95% confidence intervals. Alternative effect-size interpretation frameworks have been proposed in related fields; however, the present study followed a regression-based analytical approach [9]. In addition to statistical significance, the clinical relevance of effect sizes was considered. Effect sizes of moderate to large magnitude were interpreted as potentially clinically meaningful, even when associated p-values were borderline, provided that the direction and magnitude of the effect were consistent, and the confidence intervals suggested a non-trivial association. This approach aligns with methodological recommendations that emphasize interpreting effect sizes alongside p-values in observational research.

All participants completed a written informed consent form, and their personal information was kept strictly confidential. The study protocol was approved by the institutional ethics committee (IR.SBMU.MSP.REC.1401.282), and all procedures were carried out in accordance with ethical guidelines. Measures to protect privacy and ensure secure data handling were applied throughout the study. The consent form clearly stated that participation was voluntary and that the data would be used solely for academic purposes as part of a medical thesis project. All questionnaires were anonymous, and no identifying information was collected. The data will not be used for any non-scientific or unauthorized purposes.

This study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results

This study was conducted on 129 otolaryngologists after exclusions, and the missing data were < 1% for all variables. The mean age of the participants was 48.8 years (Standard Deviation (SD) = 8.4), with the youngest being 34 and the oldest 73.

62.8% of the participants were male, and 37.2% were female. Out of 129 participants, 48.1% had < 15 years of practice experience, and 51.9% had ≥ 15 years of practice experience. 56.6% of them performed < 10 weekly surgical operations, while 42.6% performed ≥ 10. 49.6% of participants exercised for less than 1 h per week, while 50.4% exercised for more than 1 h per week. (Table 1)

Table 1.

Characteristics of participants

Variable	n (%) or Mean ± SD	Missing
Age, years	48.8 ± 8.4 (range 34–73)	—
Women	48 (37.2%)	—
Men	81 (62.8%)	—
Years of practice < 15	62 (48.1%)	—
≥ 15 years	67 (51.9%)	—
Weekly operations < 10	73 (56.6%)	1 (0.8%)
≥ 10 operations	55 (42.6%)	1 (0.8%)
Subspecialty — Rhinology	19 (14.7%)	—
Weekly exercise ≥ 1 h	65 (50.4%)	—

Among the 129 otolaryngologists included, the most common musculoskeletal complaint was neck pain, reported by 117 participants, corresponding to a prevalence of 90.7%. Of those affected, 50.4% described the pain as mild, 39.3% as moderate, and 10.3% as severe. 18.6% of the participants reported that neck pain was interfering with their daily activities. A previous diagnosis of cervical disc herniation was reported by 11.6%.

Out of 129 participants, 31.0% reported elbow pain. Among those with a complaint of elbow pain, 32.5% reported mild, 47.5% moderate, and 20.0% severe pain. 5.4% of participants reported elbow pain that interfered with daily activities. A previous diagnosis of lateral epicondylitis was reported by 15.5%. (Tables 2 and 3, 4)

Table 2.

Prevalence of musculoskeletal outcomes

Outcome	n/N	Prevalence %	95% CI
Neck pain	117/129	90.7	84.4–94.6
Neck pain disability	24/129	18.6	12.8–26.2
Cervical disc herniation	15/129	11.6	7.2–18.3
Elbow pain	40/129	31.0	23.7–39.4
Lateral epicondylitis diagnosis	20/129	15.5	10.3–22.7
Elbow disability	7/129	5.4	2.7–10.8

CI Confidence Interval

Table 3.

Pain severity among those affected (a) neck pain severity (N = 117)

Severity	n/N	Prevalence %	95% CI
Mild	59/117	50.4	41.6–59.1
Moderate	46/117	39.3	30.8–48.6
Severe	12/117	10.3	6.0–17.1

Table 4.

Pain severity among those affected (b) elbow pain severity (N=40)

Severity	n/N	Prevalence %	95% CI
Mild	13/40	32.5	20.1–48.0
Moderate	19/40	47.5	32.9–62.5
Severe	8/40	20.0	10.5–34.8

Univariable analysis

Statistical analysis revealed that neck pain was significantly associated with age and with being over 50 years old. Participants with neck pain were older than those without (mean age 49.5 ± 8.2 vs. 42.3 ± 6.9 years), corresponding to a mean difference of approximately 7.2 years. It was also more common among participants who performed over 10 surgeries per week. However, the severity of neck pain was associated with weekly exercise, with severe pain concentrated among those who exercised less than an hour per week. Pain severity was also associated with older age and age group ≥ 50 years.

Cervical disc herniation was associated with older age, particularly in the ≥ 50 years age group. Participants with physician-diagnosed cervical disc herniation were older than those without this diagnosis (mean age 56.4 ± 8.6 vs. 47.8 ± 7.9 years), with a mean age difference of approximately 8.6 years.

Neck pain–related interference with daily activities was significantly associated with older age and lower levels of exercise.

Elbow pain was significantly more common in older participants (age ≥ 50 years), in participants with more years of practice, in participants with more weekly operations, and among rhinologists. Participants with elbow pain were older than those without (mean age 52.8 ± 8.3 vs. 47.1 ± 8.0 years), corresponding to a mean difference of approximately 5.7 years. But the pain severity and its interference with daily activities were not significantly associated with any dependent variable.

Finally, lateral epicondylitis was significantly associated with older age (≥ 50 years),> 15 years of practice, ≥ 10 weekly operations, and a rhinology subspecialty. Participants with physician-diagnosed lateral epicondylitis were older than those without the diagnosis (mean age 56.9 ± 8.9 vs. 47.5 ± 7.8 years), representing an approximate mean age difference of 9.4 years. (Table 5)

Table 5.

Bivariate associations of predictors with musculoskeletal outcomes

Exposure	Neck Pain (p-value)	Cervical Disc Herniation (p-value)	Elbow Pain (p-value)	Lateral Epicondylitis (p-value)
Age (continuous, t-test)	0.010	0.002	< 0.001	< 0.001
Age group (< 50 vs. ≥ 50, χ²)	0.023	0.018	0.001	< 0.001
Sex (χ²)	0.737 (NS)	0.169 (NS)	0.405 (NS)	0.779 (NS)
Years of practice (χ²)	0.176 (NS)	0.225 (NS)	0.018	0.025
Weekly operations (χ²)	0.019	0.422 (NS)	0.017	0.024
Weekly exercise (χ²)	0.073 (NS)	0.160 (NS)	0.748 (NS)	0.134 (NS)
Rhinology Subspecialty (χ²)	0.512 (NS)	0.165 (NS)	< 0.001	0.001

(NS = not significant at p ≥ 0.05)

The analysis was adjusted using binary logistic regression for binary outcomes (neck pain, cervical disc herniation, elbow pain, lateral epicondylitis, neck‑/elbow‑related activity limitation) and ordinal logistic regression for severity outcomes.

Multivariable analysis

In multivariable logistic regression analyses, after adjustment, elbow pain remained independently associated with older age (OR 7.35, 95% CI 1.77–30.55; p = 0.006) and rhinology subspecialty (OR 9.02, 95% CI 2.61–31.24; p < 0.001). Lateral epicondylitis showed a borderline association with older age (OR 5.81, 95% CI 0.99–34.24; p = 0.052); however, the magnitude of the effect suggests potential clinical relevance despite borderline statistical significance. It was also independently associated with rhinology subspecialty (OR 8.42, 95% CI 2.20–32.27; p = 0.002). In contrast, for neck pain, cervical disc herniation, and neck–pain–related activity limitation, no covariate met the threshold for independent significance in the adjusted models; apparent bivariable associations (e.g., with age, surgical volume, exercise) did not persist after accounting for the full set of covariates.

In summary, musculoskeletal complaints were frequent, with neck pain reported by 90.7%, elbow pain by 31.0%, cervical disc herniation by 11.6%, and physician-diagnosed lateral epicondylitis by 15.5% of participants. Importantly, after multivariable adjustment, only older age and rhinology subspecialty remained independently associated with elbow pain, with rhinology subspecialty also independently associated with lateral epicondylitis, underscoring these as the key findings of the study. No independent predictors were retained for neck pain, cervical disc herniation, or pain-related disability.

Discussion

This study aimed to assess the prevalence and factors linked to musculoskeletal complaints in Otorhinolaryngology (ENT) surgeons. Our findings revealed a high rate of musculoskeletal disorders among ENT specialists, with neck pain reported by 90.7%, elbow pain by 31.0%, physician-diagnosed lateral epicondylitis by 15.5%, and cervical disc herniation by 11.6%. In a previous study, the prevalence of musculoskeletal diseases among dentists, surgeons, and general practitioners in India was found to be 61%, 37%, and 20%, respectively [10]. However, A survey of practicing ENT surgeons (n = 403) reported 89.8% had discomfort or physical symptoms attributed to surgical practice [6], and an Irish national survey of ENT physicians found a 75.5% prevalence of work-related musculoskeletal disorders [11]. Additionally, a recent study of ENT physicians (n = 751) reported a lifetime prevalence of neck complaints at 93.0%, with 82.0% experiencing neck issues in the past 12 months [12]. These findings suggest higher rates of musculoskeletal disorders in ENT surgeons compared to other healthcare providers.

Based on National Institute for Occupational Safety and Health (NIOSH) studies, healthcare workers are at risk of musculoskeletal disorders, including neck and shoulder injuries, among which long working hours and improper posture during work have been mentioned [13]. This differs from our findings, which showed no significant relationship between elbow and neck pain and the number of surgeries performed per week. This difference may partly reflect the fact that those studies measured posture and ergonomic load directly, whereas our study assessed only weekly surgical volume. In a study on dentists, lab technicians, doctors, and hospital physiotherapists in India, prolonged work in a fixed position, working in awkward and restricted postures, and dealing with excessive patient or sample loads in a single day were identified as the primary contributing factors to musculoskeletal problems [14]. It appears that ergonomics and working posture and conditions may be more associated with musculoskeletal disorders in healthcare providers, rather than just higher working hours.

We found neck pain to be the most common complaint, with no independent predictor after adjustment for confounders. According to a systematic analysis conducted between 1990 and 2021, based on 92 studies in the general population, the prevalence of neck pain was approximately 2,450 per 100,000. It was more common in women than men and peaked between the ages of 45 and 74 [15]. In a study on surgeons [16], a study on echocardiographers [17], and another study on dentists [18], neck pain was the most commonly reported musculoskeletal problem. This suggests that working posture and long working hours may be associated with the significantly higher prevalence of neck pain in healthcare providers, especially ENT surgeons. From an ergonomic perspective, neck pain in otolaryngologists may be related to prolonged static neck flexion or rotation during microscopic and endoscopic procedures, as well as sustained visual focus on monitors positioned below eye level. These postural demands can increase cervical muscle load and fatigue, particularly during lengthy procedures, and have been previously highlighted as common ergonomic challenges in ENT practice.

Cervical disc herniation has been rarely studied in surgical specialists, and to our knowledge, no prior research has specifically reported its prevalence in otolaryngologists. In the general population, magnetic resonance imaging (MRI)-based studies have demonstrated cervical disc herniation, with prevalence increasing markedly after the age of 40 [19]. A large nationwide cohort study from Taiwan further showed that physicians overall have significantly higher odds of cervical disc herniation compared to non-medical workers (adjusted OR ≈ 1.31), particularly in surgical specialties [20]. However, ENT surgeons were not evaluated separately. Our finding represents one of the first prevalence estimates for this specialty and suggests a possible contribution of long-term cumulative cervical load associated with ENT practice.

Beyond neck pain and cervical disc herniation, elbow pain and lateral epicondylitis demonstrated distinct patterns in the adjusted analyses. Elbow pain was independently associated with older age and rhinology subspecialty. A previous diagnosis of lateral epicondylitis was also independently associated with practicing rhinology. Although the association between older age and lateral epicondylitis did not reach conventional statistical significance after adjustment, the observed effect size was large, suggesting that age may still represent a clinically relevant factor in the development of lateral epicondylitis among otolaryngologists. In occupational health research, such effect sizes are often considered meaningful, particularly when they align with plausible biomechanical mechanisms and prior evidence. According to a cohort study, the prevalence of lateral epicondylitis was approximately 1–3%, and it was more common among individuals engaged in repetitive hand and wrist activities [21]. These results suggest a higher prevalence of lateral epicondylitis among ENT surgeons, particularly older rhinologists, compared with the general population. The significant association between elbow pain and the prevalence of lateral epicondylitis in the rhinology field suggests that, due to the frequency of endoscopic surgeries and fine hand movements, these individuals are more susceptible to elbow pain and lateral epicondylitis than surgeons in other fields, such as general ENT. From an ergonomic standpoint, rhinologic procedures frequently involve prolonged endoscopic manipulation, repetitive wrist extension, forearm pronation, and sustained grip force, all of which may increase mechanical load on the lateral elbow structures.

Furthermore, our research found that gender did not significantly affect the prevalence of these conditions. This finding aligns with studies on the epidemiology of lateral epicondylitis prevalence [22]. This result is likely because lateral epicondylitis and disc herniation are more commonly associated with mechanical factors and specific types of activity. The observed associations align with known ergonomic demands of otolaryngology practice, where prolonged static postures and repetitive upper-extremity tasks are common and may contribute to musculoskeletal symptom burden.

A notable strength of this study is its comprehensive assessment of work-related musculoskeletal disorders among otolaryngologists, extending beyond symptom-based surveys. In addition to evaluating the prevalence of neck and elbow pain, we specifically examined physician-diagnosed cervical disc herniation and lateral epicondylitis. These outcomes have rarely been investigated as distinct clinical entities in ENT surgeons. By incorporating measures of pain severity and pain-related functional disability, our study provides a more nuanced characterization of musculoskeletal burden than prior studies that primarily focused on symptom presence or absence. Furthermore, the use of multivariable regression analysis allowed identification of independent associations while accounting for key demographic and occupational confounders. Importantly, the subspecialty-specific analysis revealed a particularly strong association between rhinology practice and elbow pain as well as lateral epicondylitis, highlighting how differing ergonomic demands within otolaryngology subspecialties may contribute to differential musculoskeletal risk. Together, these features represent a meaningful advancement beyond previous ENT WMSD surveys and provide clinically relevant insights to inform targeted ergonomic and preventive strategies.

However, this study has several important limitations; its cross-sectional design prevents causal inference and the establishment of temporal relationships. All outcomes, including pain severity, disability, cervical disc herniation, and lateral epicondylitis, were based entirely on self-reported data, which also introduces the risk of recall bias, misclassification, and over- or under-reporting of symptoms. No clinical examination, imaging confirmation, or objective ergonomic assessment, such as Rapid Upper Limb Assessment (RULA), Rapid Entire Body Assessment (REBA), Ovako Working Posture Assessment System (OWAS), Quick Exposure Check (QEC), or video posture analysis, was performed. This limits the ability to distinguish true pathology from perceived discomfort and restricts the interpretation of the relationship between posture and musculoskeletal outcomes. Additionally, potential selection bias and non-response bias may be present, as surgeons experiencing musculoskeletal symptoms may have been more inclined to participate, potentially inflating the prevalence estimates. The study did not account for several important potential confounders, including body mass index (BMI), stress, burnout, sleep quality, physical comorbidities, and other psychosocial factors, which may influence both occupational exposures (such as work patterns and ergonomic load) and the reporting or perception of musculoskeletal symptoms. Although the sample size was reasonable, the number of events for certain outcomes, such as cervical disc herniation and elbow-related disability, was relatively small, limiting statistical power and the stability of regression estimates. Additionally, surgical workload was broadly categorized, and the study did not differentiate among specific surgical techniques or procedure types (e.g., endoscopic vs. open, rhinology vs. otology vs. head and neck), which may entail different ergonomic risks. The study also did not capture the chronicity, duration, recurrence, or temporal patterns of symptoms, which limits comparability with studies reporting 7-day, 12-month, or lifetime prevalence. Finally, because all participants were practicing otolaryngologists from a single country, the generalizability of the findings to ENT surgeons in other healthcare systems or resource settings may be limited.

Given the high prevalence of musculoskeletal disorders, particularly among older surgeons and those working in rhinology subspeciality, these findings underscore the need for improved ergonomic awareness, potential redesign of surgical instruments, and incorporation of routine physical activity into surgeons’ wellness practices. Early screening, timely referral, and structured ergonomic training may help mitigate the progression of neck and upper-extremity disorders in this high-risk group.

Further research, ideally through longitudinal and multicenter studies, is warranted to clarify causal pathways and better characterize risks across healthcare settings. This study contributes meaningful new evidence on the burden and determinants of musculoskeletal disorders in ENT surgeons and highlights the importance of preventive strategies to protect surgeon health and sustain long-term surgical performance.

Conclusion

In this cross-sectional study, musculoskeletal complaints were highly prevalent among otolaryngologists, with neck pain being the most common symptom, and notable rates of elbow pain, cervical disc herniation, and physician-diagnosed lateral epicondylitis. After adjustment for potential confounders, only older age (≥ 50 years) and rhinology subspecialty were independently associated with elbow pain, and rhinology subspecialty was independently associated with lateral epicondylitis, while no independent associations were identified for neck pain, cervical disc herniation, or pain-related disability. Given the cross-sectional design, these findings should be interpreted as associations rather than evidence of causal relationships. From a practical perspective, the results underscore the particular importance of ergonomic awareness, including regular ergonomic training during specialty training and continuing medical education (CME), as well as targeted preventive strategies, in the rhinology subspecialty, where repetitive endoscopic work and sustained upper-extremity postures are common. Optimizing endoscopic and microscopic setup, minimizing prolonged static neck positions, reducing sustained grip force, and incorporating brief intraoperative breaks may help mitigate musculoskeletal strain, such as micro-breaks, use of adjustable equipment, and periodic workplace ergonomic assessments, particularly among older surgeons and those performing rhinologic procedures. Further longitudinal, mechanism-focused studies are warranted, as are pilot intervention studies evaluating the effectiveness of ergonomic interventions in ENT surgical practice.

Abbreviations

WMSDs

Work-related musculoskeletal disorders

KMO

Kaiser–Meyer–Olkin measure of sampling adequacy

OR

Odds ratio

STROBE

Strengthening the Reporting of Observational Studies in Epidemiology

SD

Standard Deviation

CI

Confidence Interval

ENT

Otorhinolaryngology

NIOSH

National Institute for Occupational Safety and Health

MRI

Magnetic resonance imaging

RULA

Rapid Upper Limb Assessment

REBA

Rapid Entire Body Assessment

OWAS

Ovako Working Posture Assessment System

QEC

Quick Exposure Check

BMI

Body Mass Index

CME

Continuing Medical Education

Authors’ contributions

MM performed the statistical analysis, contributed to methodology, drafted the manuscript, and participated in manuscript revision.SS contributed to manuscript drafting and manuscript review.LK contributed to data collection and conceptualization.MG provided supervision, conceptualization, and methodological oversight.All authors read and approved the final manuscript.

Funding

No funding was received for this study.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study protocol was approved by the Institutional Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.MSP.REC.1401.282). All participants provided written informed consent prior to enrollment. This study was conducted in full accordance with the ethical principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.