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ImportanceWork-related musculoskeletal disorders are common among otolaryngologists and can be associated with decreased productivity, missed workdays, and reduced quality of life. Ergonomic risk for surgeons is elevated during common otolaryngology procedures; current ergonomic interventions lack the ability to provide real-time feedback. The ability to quantify and mitigate ergonomic risk during surgery may reduce work-related musculoskeletal disorders.ObjectiveTo quantify the association of vibrotactile biofeedback with intraoperative ergonomic risk to surgeons during tonsillectomy.Design, Setting, and ParticipantsThis cross-sectional study was conducted between June 2021 and October 2021 at a freestanding tertiary care children’s hospital and included 11 attending pediatric otolaryngologists. Data analysis was conducted from August to October 2021.InterventionsReal-time quantification of ergonomic risk during tonsillectomy and the use of a vibrotactile biofeedback posture monitor.Main Outcomes and MeasuresAssociation of vibrotactile biofeedback with objective measures of ergonomic risk. Assessment tools included the Rapid Upper Limb Assessment, craniovertebral angle, and time spent in an at-risk posture.ResultsEleven surgeons (mean [SD] age 42 [7] years; 2 women [18%]) performed 126 procedures with continuous posture monitoring in the presence (80 [63%]) and absence (46 [37%]) of vibrotactile biofeedback. No complications or delays associated with the device were reported. Intraoperative vibrotactile biofeedback was associated with improved Rapid Upper Limit Assessment neck, trunk, and leg scores by 0.15 (95% CI, 0.05-0.25), improved craniovertebral angle by 1.9 (95% CI, 0.32-3.40), and decreased overall time spent in an at-risk posture by 30% (95% CI, 22%-39%).Conclusions and RelevanceThe results of this cross-sectional study suggest that use of a vibrotactile biofeedback device to quantify and mitigate ergonomic risk for surgeons is feasible and safe while performing surgery. Vibrotactile biofeedback was associated with reduced ergonomic risk during tonsillectomy and may have a role in improving surgical ergonomics and preventing work-related musculoskeletal disorders.

To measure the craniovertebral angle during tonsillectomy, assess the interrater reliability of our methodology, and investigate the correlations of the Rapid Upper Limb Assessment and the craniovertebral angle to quantify ergonomic risk.Prospective, observational study.Tertiary care pediatric institution.Neck posture was evaluated for 92 images with 7 surgeons. Lateral images of the surgeon were captured every minute in a standardized method. Images were assessed by 3 raters, measuring the craniovertebral angle, defined as the angle between a horizontal line through the C7 vertebrae and another line through C7 and the tragus of the ear. Interrater reliability of the craniovertebral angle was evaluated using the κ statistic. Per prior publications, reports of neck pain were frequent when the craniovertebral angle value was50°; thus, we defined an abnormal posture if the craniovertebral angle was50°.Mean (SD) craniovertebral angle during tonsillectomy was 26.0° (11.3°). One hundred percent of procedures had at least 1 assessment of abnormal posture. The lowest interrater reliability was 0.77 (CI: 0.67-0.87). Rapid Upper Limb Assessment and craniovertebral angle (CA) correlation was -0.12 (Poor posture during tonsillectomy places otolaryngologists at intraoperative ergonomic risk. The craniovertebral angle is a predictor of future neck pain, and a pathologic neck position during tonsillectomy was identified. Given the high interrater reliability, our approach to assessing intraoperative surgical ergonomics was validated. Overall, RULA and the CA are not a substitute for one another but complementary.

Despite the advantages of tracheostomy placement in children requiring prolonged mechanical ventilation, vocalization and verbal communication remains limited in this population of children. The lack of these essential elements during a critical period of development can have a negative impact on overall development. In ventilator dependent children, in-line speaking valves (ISV) provide an opportunity for initiating speech and communication. The objective of this study is to examine patient characteristics and risk factors associated with tolerance and success of ISV trials performed with mechanically ventilated children.A retrospective cohort study was conducted at a large, tertiary care children's hospital to evaluate the outcomes of ISV trials in ventilator-dependent children with tracheostomies, from 2009 to 2019. The primary endpoints were tolerance of the initial ISV assessment, and successful completion of a trial. We compared demographic and clinical characteristics among children that had a successful ISV trial to those that did not.Eighty-nine patients were included, 56 (62%) were male and 33 (38%) were female. Overall, 76 (85%) patients completed an ISV assessment and trial successfully during their hospitalization. The number of attempts before completing a successful trial varied with 41 (46%) patients succeeding on the first attempt. Children that underwent a tracheostomy for airway obstruction were more likely to fail.Ventilator-dependent children with complex comorbidities demonstrate excellent tolerance of in-line speaking valves. Patients should be selected for ISV trials in a multidisciplinary setting. Airway obstruction as an indication for tracheostomy placement is a significant predictor of failure for ISV trials.

To compare the incidence of middle ear effusion (MEE) at the time of bilateral tympanostomy tube insertion (BTI) for recurrent acute otitis media (rAOM) patients initially seen in-office or via telehealth.After obtaining IRB approval from Nationwide Children's Hospital, a total of 524 patients evaluated for rAOM were retrospectively reviewed after being divided into two cohorts: those seen via a telehealth visit from April to June of 2020 (n = 140), and those seen via an in-person visit from April to June of 2019 (n = 384). Recommendation for BTI was captured for each patient following their visit. Clinical characteristics documented at the time of the visit, such as history of intramuscular (IM) antibiotic use and hearing or speech concerns were also captured to determine whether both telehealth and in-person cohorts were similar in clinical presentation. For BTI patients, the presence or absence of MEE in either ear at the time of BTI was recorded. Patients with cleft palate or prior BTI were excluded.51.43% (72/140) of patients in the telehealth cohort were recommended for BTI. Of those recommended, 87.50% (63/72) underwent BTI. Of these, 31.75% (20/63) had a MEE at the time of BTI. In the in-office cohort, 69.01% (265/384) of patients were recommended for BTI. Of those recommended, 92.83% (246/265) underwent BTI. Of these, 69.92% (172/246) had a MEE at the time of BTI.There were significantly less middle ear effusions in the telehealth cohort compared to the in-office cohort (p 0.0001). It is well understood that telehealth is limited in its physical exam capabilities. It is possible that the use of telehealth for the surgical management of rAOM may lead to more procedures on patients without MEE.