Risk of Noise-Induced Hearing Loss for Orthopaedic Surgeons

Abstract

Background:Noise-induced hearing loss (NIHL) affects the ability of an individual to communicate and can negatively impact quality of life. The risk to orthopaedic surgeons of developing NIHL as a result of occupational exposures in the operating room (OR) is currently unknown. Hearing protection is recommended for levels of >85 decibels (dB), irrespective of length of exposure. The primary goal of the present study was to determine whether orthopaedic surgeons are exposed to harmful noise levels in the OR that puts them at risk for developing NIHL.Methods:A prospective review was conducted with use of intraoperative audio recordings across 6 orthopaedic subspecialties. Recordings were made in ORs prior to the surgical start time to serve as baseline controls. Decibel levels were reported as the maximum dB level (MDL), defined as the highest sound pressure level during the measurement period, and as the time-weighted average (TWA), defined as the average dB level projected over an 8-hour time period. Noise doses were reported as the percentage of maximum allowable daily noise (dose) and as the measured dose projected forward over 8 hours (projected dose).Results:Three hundred audio recordings were made and analyzed. The average MDL ranged from 96.9 to 102.0 dB, with noise levels for all subspeciality procedures being significantly greater compared with the control recordings (p < 0.001). Overall, MDLs were >85 dB in 84% of cases and >100 dB in 35.0% of cases. The procedure with the highest noise dose was a microdiscectomy, which reached 11.3% of the maximum allowable daily noise and a projected dose of 104.1%. Among subspecialties, adult reconstruction had the highest dose and projected dose per case among subspecialties.Conclusions:The present results showed that orthopaedic surgeons are regularly exposed to damaging noise levels (i.e., >85 dB), putting them at risk for permanent hearing loss. Further investigation into measures to mitigate noise exposure in the OR and prevent hearing loss in orthopaedic surgeons should be undertaken.Clinical Relevance:Orthopaedic surgeons are at risk for NIHL as a result of occupational exposures in the OR.

The relationship between exposure to noise and hearing loss in orthopaedics

“…Three used a specific number of operations for this definition, 11,12,23 and three simply recorded the length each operation and extrapolated their data across eight hours. 21,22,24 Details of the time-weighted exposure to noise during eight hours are shown in Table IV.…”

“…the search strategy (table i) produced 1,558 studies which, after reviewing the titles, abstracts, and full text, were narrowed down to 15 as shown in the PRISMA flowchart (Figure 1). Seven reviewed noise generated from specific orthopaedic instruments and machines; [10][11][12][13][14][15][16] 11 reviewed noise generated from complete operations, [11][12][13][17][18][19][20][21][22][23][24] one of which simulated total knee arthroplasty (tKa) on porcine cadaveric bones. 11 three involved both operations and instruments.…”

“…[11][12][13] a total of 13 studies dealt with elective arthroplasties (total hip (tHa) and total knee arthroplasty (tKa)), one reviewed two theatres including 12 operations with both elective and trauma cases, 12 and another included various subspecialities including arthroplasty, hand, spine, foot and ankle surgery, and sports medicine. 24 Only one study included a control group, 21 comparing 20 arthroplasties, ten each of tHas and tKas, with ten knee arthroscopic operations.…”

“…The authors of five studies suggested new orthopaedic instruments should be designed to be quieter. 12,13,17,19,24 Sydney et al 11 and Peters et al 13 tested new equipment, comparing it with older equipment, and while the newer equipment was quieter, the recommended guidelines were still exceeded at times. Further research is needed to test whether newer instruments might reduce the noise generated in the operating theatre to a safe occupational level.…”

Research

“…In this investigation from Stratford (New Jersey, USA) , a team of concerned surgeons have investigated the risk to hearing from the use of power tools in the orthopaedic operating theatre. 1 Audio recording from theatres in six orthopaedic specialties were analyzed and the decibels averaged over eight hours. A total of 300 recordings were analyzed, with an average reported volume of between 96.9 and 102 dB.…”