Occupational Noise Exposure in Foot and Ankle Surgery and the Risk of Noise-Induced Hearing Loss

Occupational exposure to high levels of noise increases the risk of noise-induced hearing loss (NIHL), resulting in significant long-term quality of life implications. Hearing protection is recommended if occupational noise exposure routinely exceeds 85 decibels (dB). The purpose of this study was to determine if foot and ankle surgeons are exposed to excessive levels of noise, thus putting them at an increased risk for NIHL.

A prospective review was conducted of intraoperative recordings during a variety of foot and ankle procedures. Recordings were categorized into 3 subgroups: trauma, deformity correction and degenerative conditions, and soft tissue procedures. Noise levels were reported as maximum dB level (MDL) and time-weighted average (TWA), defined as the average dB level projected over an 8-hour period. Dose was reported as the percentage of allowable daily noise, with projected dose reported as the measured dose projected over an 8-hour period.

A total of 147 operative recordings consisting of 64 (44%) deformity correction and degenerative conditions, 40 (27%) soft tissue procedures, and 43 (29%) trauma cases were collected. Maximal and average noise exposures were similar for all procedures (P = .077; P = .090), with an average MDL of 98.9 dB (range, 87.9-109.2) and TWA of 60.5 dB. Procedures also did not significantly differ in dose (P = .273), even when projected over an 8-hour period (P = .362). The average MDL of total ankle arthroplasty (TAA) and hindfoot arthrodesis procedures was 101.5 dB (range, 93.9-109.2), with 52% of all deformity correction and degenerative procedures having an MDL over 100.0 dB.

Foot and ankle surgeons are typically not exposed to dangerous levels of occupational noise as per National Institute for Occupational Safety and Health recommendation; however, specific procedures, such as arthrodesis and TAA, routinely achieve noise levels that are above the recommended limits.