Can Earmuffs in the OR Cut Postoperative Nausea?
Postoperative nausea and vomiting is still one of the most common complaints I hear in recovery, even when a patient has had good prophylaxis. A randomized trial published online in Anesthesiology on November 5, 2026 tested something refreshingly simple: putting noise blocking earmuffs on patients from induction until the end of surgery. In women having gynecologic laparoscopy, nausea and vomiting over the first 48 hours was less common with the earmuffs. It is one trial, but it is a cheap, low risk idea worth taking seriously.
The study
Fu, Hu, and colleagues ran a single center trial in women 18 to 65 years old having elective gynecologic laparoscopic surgery. That is a group at high baseline risk for nausea. Patients were randomized to wear passive noise attenuating earmuffs from induction to the end of the case, or to usual care. Every patient received two antiemetics, dexamethasone and palonosetron. Patients and outcome assessors were blinded. The primary outcome was any nausea, retching, or vomiting within 48 hours, tracked in recovery, up to 24 hours, and from 24 to 48 hours.
Of 364 patients screened, 192 were randomized. Nausea or vomiting within 48 hours occurred in 34 of 96 women (35.4%) with earmuffs and 50 of 96 (52.1%) with usual care, an adjusted risk difference of about 18 percentage points (95% CI 4.0 to 31.8 points lower; P = 0.012). The benefit looked similar across the three time windows. Severity and retching also favored the earmuffs, and the share of patients with a complete response was 72.9% versus 56.2%. Quality of recovery, adverse events, and opioid exposure did not clearly differ.
How I read it
The idea behind it is plausible. Hearing does not switch off completely under a clinically adequate general anesthetic, and operating rooms are loud. Suction, alarms, instruments, music, and conversation all add up. Whether that sound burden feeds into nausea has not been tested much, so a randomized trial is welcome.
I would still hold the result loosely for now. This was one center, fewer than 200 patients, and only women having one type of surgery. The confidence interval is wide, so the true effect could be much smaller than 18 points. Blinding patients to earmuffs is also harder than it sounds, since some could notice them on waking. A few of the supportive endpoints were added after the fact. And the trial does not tell us whether the benefit comes from noise itself or from something else that changes when the room is quieter for the patient.
What it means for practice here
In Casper and anywhere else, the appeal is obvious. Earmuffs cost very little, add no drug, and carry almost no risk as long as they do not get in the way of monitoring, positioning, or airway access. I would not drop a proven antiemetic in exchange for them. For a high risk patient who has had bad nausea before, though, I can see adding something this harmless on top of standard prophylaxis while larger, multicenter trials sort out whether the effect holds. It is also a good reminder for all of us in the room that the patient may be taking in more of our noise than we think.
Source
- Fu C, Hu X, Tao D, et al. Intraoperative noise isolation and postoperative nausea and vomiting after gynecological laparoscopic surgery: a randomized controlled trial. Anesthesiology. Published online November 5, 2026. doi:10.1097/ALN.0000000000006466. Article page
This post is clinician commentary for educational discussion. It is not medical advice for any reader's personal care. Anesthesia and perioperative decisions should be made with the treating clinician based on the individual patient's circumstances.