International Rhinologic Society Rhinology 0300-0729 2026 06 04 Work-related musculoskeletal disorders in endoscopic sinus and skull base surgeons: an international survey EN R.G CampbellFaculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia J.R. Zadro Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia C.L. Chan Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia M.G. Mackey Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia A. Nettel-AguirreSchool of Social Sciences, University of Wollongong, Australia School of Social Sciences, University of Wollongong, Australia R.G. Douglas Department of Surgery, University of Auckland, Auckland, New Zealand A.R. Gamble Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia E. PappasFaculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia Shanghai University of Medicine and Health Sciences, China Journal Article 3427 10.4193/Rhin25.633 BACKGROUND: Endoscopic sinus and skull base surgeons are at high risk of work-related musculoskeletal disorders (WRMD) due to the unique ergonomic risks inherent in this specialty. These musculoskeletal disorders may negatively impact surgeons and their patients. The primary aim of this international survey was to quantify this problem globally and evaluate its associated factors. METHODS: A 46-item electronic survey was distributed to endoscopic sinus and skull base surgeons at any career stage via multiple international professional societies. RESULTS: We received 1385 responses. The prevalence of WRMD in the previous week and 12 months was 44.2% and 66.5%, respectively. The neck, shoulders, lumbar spine and wrists were the most commonly involved body parts, and most surgeons had symptoms in multiple body parts. Work-related musculoskeletal disorders were reported to negatively impact work, hobbies, activities of daily living and sleep, and to shorten careers in respondents. Factors associated with higher odds of WRMD included female sex, BMI ≥30kg/m2, being an attending otolaryngologist, having a high surgical and clinic caseload (performing ≥100 ESSB procedures annually), and operating in standing. Regular exercise (≥ 7 hours weekly) and an endomorphic somatotype were associated with lower odds of WRMD. CONCLUSIONS: Endoscopic sinus and skull base surgeons have a high prevalence of WRMD. Modifiable risk factors include surgical volume, clinic time, operating position, and regular exercise. We make recommendations to assist in the reduction of WRMD in this population.