LETTERS
decreases stress,1 enhances concentration, can improve motor skill performance,2,3 and often diminishes patient anxiety.4-7 In summary, suggesting that music is dangerous in the OR environment based on the data from this study is misleading. As surgeons who enjoy the multiple benefits of music in the OR, we hope that appropriate music is encouraged in this unique and focused setting.
Effect of Noise on Auditory Processing in the Operating Room Anthony R MacLean, MD, FRCSC, FACS, Elijah Dixon, MD, FRCSC, FACS, Chad G Ball, MD, FRCSC, FACS Calgary, AB, Canada We read with interest the article by Way and colleagues1 on the effect of noise on auditory processing in the operating room (OR). Unfortunately, we have several concerns about this study. First, we must challenge Dr Way’s methodology. It appears as though the authors intentionally designed the study to show that music is detrimental to communication. Their SPIN-R was presented at 70 dB SPL, but the OR noise and music combined to approach 74.2 dB SPL. Even if 74.2 dB is the average noise level found in their local ORs, attempts at communication in this environment would never be softer than the background noise. We believe that no matter where you set the baseline noise threshold, if the SPIN-R is presented at a lower level, it must surely affect comprehension. The authors do mention the Lombard effect in their discussion, but don’t account for it in their study design, which we believe is a critical flaw. This concept is essential to communicating in any environment where background noise is prominent. Second, it is interesting that in the high predictability scenario (Fig. 4), there is essentially no visible drop off in performance with the addition of music, despite the stated “significant difference.” Perhaps the authors can comment on how the flat line from noise to noise plus music becomes significant. Third, limiting testing to surgeons is likely a suboptimal manner to assess the true effects of noise on auditory processing in the OR. More specifically, the effects of noise affect all staff in the OR rather than just the surgeon (ie, nurses and anesthesiologists). In this day and age, miscommunication can be mitigated by a routine and organized briefing or timeout. When new information needs to be provided during the course of a procedure, it should, of course, be provided in a clear, strong voice. This may even require briefly turning off music and/or stopping concurrent conversations. Furthermore, music has previously been shown to have many beneficial effects in the OR environment. Music
ª 2013 by the American College of Surgeons Published by Elsevier Inc.
REFERENCES 1. Way TJ, Long A, Weihing J, et al. Effect of noise on auditory processing in the operating room. J Am Coll Surg 2013;216: 933e938. 2. Allen K, Blascovich J. Effects of music on cardiovascular reactivity among surgeons. JAMA 1994;272:882e884. 3. Conrad C, Konuk Y, Werner P, et al. The effect of defined auditory conditions versus mental loading on the laparoscopic motor skill performance of experts. Surgical Endosc 2010;24: 1347e1352. 4. Makama JG, Ameh EA, Eguma SA. Music in the operating theatre: opinions of staff and patients of a Nigerian teaching hospital. African Health Sci 2010;10:386e389. 5. Chetta HD. The effect of music and desensitization on preoperative anxiety in children. J Music Ther 1981;18:74e87. 6. Stevens K. Patients’ perceptions of music during surgery. J Advanced Nursing 1990;15:1045e1051. 7. Ni CH, Tsai WH, Lee LM, et al. Minimising preoperative anxiety with music for day surgery patients - a randomised clinical trial. J Clin Nursing 2012;21:620e625.
Disclosure Information: Nothing to disclose.
Reply T Justin Way, MD, Ashleigh Long, PhD, Jeff Weihing, PhD, Rosalind Ritchie, MD, Raleigh Jones, MD, Matthew Bush, MD, Jennifer B Shinn, PhD Lexington, KY The authors appreciate the concerns raised by Drs MacLean, Dixon, and Ball in their recent letter regarding our investigation, “Effect of noise on auditory processing in the operating room.”1 This investigation, as clearly stated in the manuscript, was intended to be a preliminary investigation that attempted to replicate as closely as possible listening performance in the operating room.
1154
ISSN 1072-7515/13/$36.00 http://dx.doi.org/10.1016/j.jamcollsurg.2013.08.008
decreases stress,1 enhances concentration, can improve motor skill performance,2,3 and often diminishes patient anxiety.4-7 In summary, suggesting that music is dangerous in the OR environment based on the data from this study is misleading. As surgeons who enjoy the multiple benefits of music in the OR, we hope that appropriate music is encouraged in this unique and focused setting.
Effect of Noise on Auditory Processing in the Operating Room Anthony R MacLean, MD, FRCSC, FACS, Elijah Dixon, MD, FRCSC, FACS, Chad G Ball, MD, FRCSC, FACS Calgary, AB, Canada We read with interest the article by Way and colleagues1 on the effect of noise on auditory processing in the operating room (OR). Unfortunately, we have several concerns about this study. First, we must challenge Dr Way’s methodology. It appears as though the authors intentionally designed the study to show that music is detrimental to communication. Their SPIN-R was presented at 70 dB SPL, but the OR noise and music combined to approach 74.2 dB SPL. Even if 74.2 dB is the average noise level found in their local ORs, attempts at communication in this environment would never be softer than the background noise. We believe that no matter where you set the baseline noise threshold, if the SPIN-R is presented at a lower level, it must surely affect comprehension. The authors do mention the Lombard effect in their discussion, but don’t account for it in their study design, which we believe is a critical flaw. This concept is essential to communicating in any environment where background noise is prominent. Second, it is interesting that in the high predictability scenario (Fig. 4), there is essentially no visible drop off in performance with the addition of music, despite the stated “significant difference.” Perhaps the authors can comment on how the flat line from noise to noise plus music becomes significant. Third, limiting testing to surgeons is likely a suboptimal manner to assess the true effects of noise on auditory processing in the OR. More specifically, the effects of noise affect all staff in the OR rather than just the surgeon (ie, nurses and anesthesiologists). In this day and age, miscommunication can be mitigated by a routine and organized briefing or timeout. When new information needs to be provided during the course of a procedure, it should, of course, be provided in a clear, strong voice. This may even require briefly turning off music and/or stopping concurrent conversations. Furthermore, music has previously been shown to have many beneficial effects in the OR environment. Music
ª 2013 by the American College of Surgeons Published by Elsevier Inc.
REFERENCES 1. Way TJ, Long A, Weihing J, et al. Effect of noise on auditory processing in the operating room. J Am Coll Surg 2013;216: 933e938. 2. Allen K, Blascovich J. Effects of music on cardiovascular reactivity among surgeons. JAMA 1994;272:882e884. 3. Conrad C, Konuk Y, Werner P, et al. The effect of defined auditory conditions versus mental loading on the laparoscopic motor skill performance of experts. Surgical Endosc 2010;24: 1347e1352. 4. Makama JG, Ameh EA, Eguma SA. Music in the operating theatre: opinions of staff and patients of a Nigerian teaching hospital. African Health Sci 2010;10:386e389. 5. Chetta HD. The effect of music and desensitization on preoperative anxiety in children. J Music Ther 1981;18:74e87. 6. Stevens K. Patients’ perceptions of music during surgery. J Advanced Nursing 1990;15:1045e1051. 7. Ni CH, Tsai WH, Lee LM, et al. Minimising preoperative anxiety with music for day surgery patients - a randomised clinical trial. J Clin Nursing 2012;21:620e625.
Disclosure Information: Nothing to disclose.
Reply T Justin Way, MD, Ashleigh Long, PhD, Jeff Weihing, PhD, Rosalind Ritchie, MD, Raleigh Jones, MD, Matthew Bush, MD, Jennifer B Shinn, PhD Lexington, KY The authors appreciate the concerns raised by Drs MacLean, Dixon, and Ball in their recent letter regarding our investigation, “Effect of noise on auditory processing in the operating room.”1 This investigation, as clearly stated in the manuscript, was intended to be a preliminary investigation that attempted to replicate as closely as possible listening performance in the operating room.
1154
ISSN 1072-7515/13/$36.00 http://dx.doi.org/10.1016/j.jamcollsurg.2013.08.008
