Purpose <p>To describe the ergonomic challenges inherent to otolaryngology–head and neck surgery and to synthesize current evidence on their impact on surgeon wellness, performance, and career sustainability.</p> Methods <p>This narrative review integrates published literature addressing ergonomic risk factors across otolaryngology subspecialties, operative modalities, and clinical settings. Key themes include posture-related strain, visualization systems, operating room design, gender-based anthropometric mismatch, and mitigation strategies reported in observational studies, surveys, and ergonomic frameworks.</p> Results <p>The literature consistently demonstrates a high prevalence of work-related musculoskeletal disorders among otolaryngologists, most commonly affecting the neck, shoulders, and back. Ergonomic burden varies by subspecialty and surgical modality and is driven by sustained cervical flexion, static postures, asymmetric upper-limb loading, visual strain, and noise exposure. Female surgeons experience a disproportionate ergonomic burden related to mismatch between body dimensions and equipment design, resulting in added cognitive and workflow demands. These factors are associated with pain, reduced efficiency, burnout, and, in severe cases, early modification or cessation of operative practice.</p> Conclusion <p>Ergonomic strain in otolaryngology is widespread, cumulative, and modifiable. Incorporating precision ergonomics, individualized operating room configuration, microbreaks, and early ergonomic education into surgical practice and training is essential to preserve surgeon health, optimize performance, and ensure long-term workforce sustainability.</p>