Saudi Journal of Otorhinolaryngology Head and Neck Surgery

: 2018  |  Volume : 20  |  Issue : 2  |  Page : 56--61

Neck Pain Among Otolaryngologists, Head and Neck Surgeons

Ahmed Alem1, Lujain Abdalwassie2, Abdallah Abdulkarin Alharbi2, Elaf Alaadah2, Amro Hamdi3, Talal Al- Khatib4,  
1 Ibn Sina College of Medicine, King, Jeddah, Saudi Arabia
2 College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Orthopedics, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
4 Department of Otorhinolaryngology, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Address:
Abdallah Abdulkarin Alharbi
College of Medicine King Abdulaziz University, Jeddah
Saudi Arabia


Introduction: Neck pain is one of the most frequent complaints among the general population, especially for health care professionals and otolaryngologists, who are likely to develop work-related neck pain . Objective: To determine the prevalence of neck pain among otolaryngologists and head and neck surgeons (ORL HNS). This study also aimed at assessing the effects of neck pain on overall quality of life. Subjects and Methods: A cross-sectional study was conducted during the 10th International Saudi Otorhinolaryngology Head & Neck Surgery Conference in March 2016, Jeddah, Saudi Arabia. The study included ORL HNS. Results: A total of 92 ORL HNS participated in the survey. General ORL doctors comprised the majority of respondents (32.6%), followed by rhinologists (28.3%). Most physicians (48.9%) had practiced for 5–20 years. A high proportion of respondents (81.4%) complained of neck pain; of these, 14.1% reported that this symptom was affecting their work. Some respondents reported stiffness (49.2%), weakness (5.1%), or paresthesia (8.5%). The Neck Disability Index showed that 34.8% of the respondents had mild disability; 54.3% had moderate disability whereas 10.9% had severe disability. Conclusion: The number of surgery days per month and duration of practice appeared to affect physicians’ quality of life, suggesting that workload increases neck symptoms.

How to cite this article:
Alem A, Abdalwassie L, Alharbi AA, Alaadah E, Hamdi A, Al- Khatib T. Neck Pain Among Otolaryngologists, Head and Neck Surgeons.Saudi J Otorhinolaryngol Head Neck Surg 2018;20:56-61

How to cite this URL:
Alem A, Abdalwassie L, Alharbi AA, Alaadah E, Hamdi A, Al- Khatib T. Neck Pain Among Otolaryngologists, Head and Neck Surgeons. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2018 [cited 2023 Feb 3 ];20:56-61
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Full Text


Neck pain is one of the most frequent complaints among the general population. It is defined as neck pain that lasts for one day, with or without referral to one or both upper limbs [1]. The prevalence of neck pain worldwide is reported to range between 0.4% and 86.8% (mean, 23.1%). Unfortunately, the authors stated difficulties in comparing and pooling data from different studies due to the broad heterogeneity between epidemiological studies of neck pain. However, the estimated incidence of neck pain in one year ranges from 10.4% to 21.3% [2]. Various wrong physical behaviors may cause neck pain, including repetitive work, prolonged cervical spine flexion, high psychological job strain, smoking, and previous neck and shoulder injuries. The diagnosis of this condition is symptom-based due to the absence of objective diagnostic criteria. It can manifest as headaches, dizziness, radiating pain to the shoulders and upper limb, pain and stiffness in the neck [3].

Neck pain is not uncommon among health care professionals and otolaryngologists are particularly vulnerable to this condition. This can be due to posture during surgical procedures, such as microscope usage and looking into monitors while performing endoscopic sinus surgeries or rigid bronchoscopies. A prospective study conducted in Amsterdam reported an increased risk of neck pain for people working with the neck flexed at 20° [4].

A recent study showed that musculoskeletal pain was the most commonly reported occupational hazard among United Kingdom (UK) otolaryngologists. It accounted for 47.4% of all occupational hazards, followed by stress/psychiatric morbidities (38.4%), and sharps injuries (26.6%)[5]. Another UK study conducted to determine the prevalence of back and neck pain among otolaryngology consultants demonstrated that 72% of 325 consultants had either back or neck pain, or in some cases, even faced both. Otolaryngology surgery was directly linked to symptoms in 53% of participants.

Otologists were found to be highly affected due to prolonged sitting to conduct microscopy work [6].

The aim of this study was to determine the prevalence of neck pain among otolaryngologists and head and neck surgeons and aimed at identifying the most affected subspecialty, as well as the relationship between neck pain and duration of field practice. Furthermore, this work assessed the effect of neck pain on physicians’ quality of life.

 Material and Methods

This cross-sectional study was approved by the Research Ethics Committee at King Abdul- Aziz University (document number 217-16). th

A validated self-administered questionnaire was distributed during the 10 International Saudi Otorhinolaryngology Head & Neck Surgery Conference, which was conducted over the course of three days in March 2016, Jeddah, Saudi Arabia.

Participants were recruited by four of the coauthors, with each assigned to a specific lecture hall (e.g. otology, rhinology, head and neck, and pediatrics). Questionnaires were handed to the otolaryngologists upon entry into the lecture halls, and the filled in questionnaires were collected upon the participants’ exits. Doctors from other specialties, allied health professionals, interns, and students were excluded and were not given a copy of the questionnaire.

The questionnaire had three main components. The first part was designed to collect demographic data, including the subspecialty of the physician, years of field experience, and the number of surgery days per month. The second part contained questions regarding symptoms, and the last part included the Neck Disability Index (NDI) which indicated pain intensity. It had 10 elements: pain intensity, personal care, lifting, sleeping, driving, recreation, headache, concentration, reading, and work. The original report provided scoring intervals for interpretation [Table 1].{Table 1}

Data Analysis

The data were stored at the principal investigator’s office and accessed only by the authors. The Statistical Package for Social Sciences (SPSS Inc., Armonk, IBM, US), version 20 was used to analyze the data. Descriptive and comparative analyses were conducted. Results are presented as mean (standard deviation) or absolute value (%) as appropriate. The chi–square test was used to compare categorical variables between groups. Multinomial logistic regression was used to evaluate the role of confounding factors on the final results. Pain intensity was taken as a dependent variable, with other variables as independent. A probability (P) < 0.05 was considered significant.


Of the 1300 registered conference attendees, 93 otolaryngologists completed the questionnaire. The registered attendees included family physicians, audiologists, speech pathologists, nurses, and medical and allied health science students. We could not identify the number of registered otolaryngologists who attended the conference, but the total number of otolaryngologists registered as members in the Saudi Society was < 500.

The participants’ specialties, years of experience, and surgery days per month are shown in [Table 2]. The largest proportion of respondents (26%) possessed between 10 and 20 years of clinical practice, and 37% performed surgery six days per month. Approximately 65% of the otolaryngologists suffered from neck-related symptoms [Table 3], but only 14% lost time from work due to their symptoms. About 20% needed physiotherapy to lessen pain. The majority of otolaryngologists did not require a chiropractor or osteopathy. Similarly, none had required surgical intervention.{Table 2}{Table 3}

Using the NDI, it turned out that 34.8% of otolaryngologists had mild disability, 54.3% had moderate disability, and 10.9% had severe disability. Detailed responses to the NDI questionnaire are as shown in [Table 4]. We cross tabulated NDI with specialty [Table 5], years of experience [Table 6], and days of surgery per month [Table 7] and found that 75% of head and neck surgeons suffered from moderate pain. In addition, moderate neck pain was observed in 77.8% of surgeons who had practiced for more than 20 but less than 30 years. Operating three days per month was associated with moderate neck pain in 66% of the surgeons.{Table 4}{Table 5}{Table 6}{Table 7}

Multivariate regression analysis revealed that laryngologists had higher odds of mild pain compared to their colleagues in other specialties (odds ratio = 0.66; p-value = 0.695). Further analysis demonstrated that duration of clinical practice was associated with an increase in pain intensity; however, the difference was not statistically significant. Surgeons who performed surgery three or more days per month had 16 times more moderate pain than their colleagues who performed surgery less frequently (P-value ≤ 0.05).


Neck pain is a frequent complaint in the general population, with a reported prevalence of 0.4% to 86.8% worldwide [2]. Neck pain can be accompanied by other symptoms such as stiffness, headaches or even paresthesia. Otolaryngologists are more prone to neck pain due to the nature of their work. In this research, we asked otolaryngologists whether neck pain affected their daily lives and work using the NDI.

We found that 65.2% of otolaryngologists suffered from neck-related symptoms. Similarly, 62 % of American pediatric otolaryngologists reported experiencing pain or discomfort, which they attributed to their surgical practice [8]. In our research, otolaryngologists also reported experiencing stiffness (49.2%), weakness (5.1%), and paresthesia (8.5%). Surprisingly only 14.1% reported missing days of work, with 23.08% missing an average of 3–4 days per year.

This is relatively low compared to the research findings conducted amongst otolaryngologists in the UK, where 22.9% reported taking time off work [9].

Neck pain treatment is usually intended to reduce symptoms and improve function and may include physical exercise, rehabilitation, and chiropractic treatment. When asked about the treatment received for neck pain, 19.6% of the respondents reported having physiotherapy, 6.5% had osteopathy, 5.4% had chiropractic therapy, but none reported having neck surgery.

The NDI was used to assess the effects of pain on the surgeons’ lives, as well as degrees of disability, which ranged from mild, moderate to severe. The results demonstrated that 34.8% suffered from mild pain, 54.3% moderate pain, and 10.9% severe pain. The participants’ responses also indicated that the most affected daily activity was reading, with 46.7% reporting slight neck pain while reading. In addition, 53.3% reported infrequent headaches.

By cross tabulating the NDI score with specialty, we detected a pattern of moderate pain, especially among rhinologists and head and neck surgeons. This might be due to the fact that rhinologists flex their necks to face the monitor during surgeries, assuming an abnormal posture throughout an extended period. On the other hand, neck pain for head and neck surgeons might be due to long surgery hours and the weight of head lights.


This study possesses all the limitations inherent to cross-sectional surveys. First, it is limited by the small number of otolaryngologists with different subspecialties. Second, we did not take into consideration surgeons’ sitting or standing habits during surgery in the questionnaire. Neither did we consider the average duration and the number of operations surgeons performed per day. In addition, we failed to document surgeons’ habits during their routine clinical practices.


Overall, these analyses demonstrate that certain subspecialties and habits are associated with increased likelihood of neck pain and disability. Specifically, most otolaryngologists suffered from neck-related symptoms, with half reporting moderate neck pain.

The head and neck specialty, duration of practice (20–30 years), and frequency of surgical procedures performed (three or more days per month) were risk factors for moderate neck pain. Work-related pain required physiotherapy in 20% of the respondents and warranted time off work in about 14% of the cases.


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