Editorial Commentary: Arthroscopic Surgery Is Not Silent; Repetitive Peak Noise Exposure During Surgery May Represent...

Orthopaedic surgeons are routinely exposed to a variety of occupational hazards in the operating room; however, intraoperative noise exposure remains an underrecognized risk that may contribute to the development of occupational noise-induced hearing loss. Although traditional metrics such as time-weighted average noise levels (average decibels [dBA] over an 8-hour period) below 85 dBA may be considered low risk, repeated intraoperative exposure to maximum decibel levels ≥85 dBA may represent a clinically relevant cumulative hazard. These concerns are further supported by recent high-level evidence, suggesting that orthopaedic spine and arthroplasty surgeons are frequently exposed to hazardous intraoperative noise levels and that a substantial proportion may exhibit evidence of noise-induced hearing loss; however, few studies have specifically evaluated the intraoperative noise patterns during arthroscopic surgeries. Recent evidence suggests that maximum decibel levels consistently exceed recommended safety thresholds (≥85 dBA) across shoulder, hip, and knee arthroscopic procedures. Although shoulder arthroscopy may be associated with the highest intraoperative maximum decibel levels, potentially due to the closer proximity of noise-generating instruments to the surgeon when procedures are performed with the patient in the beach-chair position, elevated noise exposure is observed across all arthroscopic procedures. As such, the selective use of hearing protection or consideration of modifiable procedural factors, such as patient positioning, may be appropriate during the higher risk, noise-generating arthroscopic procedures. Ultimately, continued efforts to better understand cumulative intraoperative noise exposure, procedure-specific variability, and mitigation strategies are needed to optimize the long-term occupational health of sports medicine surgeons.