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The purpose of this study was to evaluate the impact of patient positioning on physician ergonomics during in-office otologic procedures. A previous simulation study suggested that placing patients supine during in-office otology procedures is ergonomically favorable. This study aims to substantiate these findings during the routine care of patients in an otolaryngology practice setting.Observational study.Outpatient otology clinic within tertiary care facility.Two neurotology attending physicians.Physicians performed cerumen removal procedures in the office with patients either in the seated position (n = 24) or supine position (n = 24).The rapid upper limb assessment (RULA), a validated instrument that measures body positioning with a focus on the upper arm, was used to measure ergonomic positioning. RULA scores correlate occupational body positioning with a numeric representation of musculoskeletal injury risk ranging from 1 (minimal risk) to 7 (very high risk).Overall median RULA scores were 4.5 (medium risk) with patients in the seated position, and 2 (low risk) with patients in the supine position (p < 0.0001). Similarly, RULA scores were significantly lower with patients in the supine position when each physician was evaluated independently (p < 0.0001, for both).Placing patients in a supine position for cerumen removal results in more favorable ergonomic positioning for the physician, thus reducing risk for work-related musculoskeletal disorders. This suggests that physicians should consider placing patients in the supine position for in-office otologic procedures. Further study is needed to investigate optimal ergonomic positioning for other common otolaryngology procedures.