Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abscess, Peritonsillar


Medical Codes

ICD-9-CM:
475 - Peritonsillar Abscess

Related Terms

  • Abscess of Tonsil
  • Quinsy

Overview

A peritonsillar abscess (PTA) is a collection of pus (purulent material) between the tonsils and the peritonsillar tissue (tonsillar capsule) at the back of the throat. Current clinical opinion is that PTA may originate in the 20 to 25 mucous salivary glands (Weber's glands) that lie above the tonsils in the soft palate, connecting to the tonsils by a duct (Galioto).

The abscess usually occurs as a complication of acute tonsillitis. It can significantly prolong recovery from tonsillitis.

The infection generally begins with an acute tonsil infection that spreads within the soft tissue at the back of the throat, first becoming cellulitis before it actually forms an abscess. Because the peritonsillar space consists of loose connective tissue, tonsils infection may result in progressive inflammation and rapid formation of purulent material. Thus, the total area of inflamed tissue and infection can be quite extensive, involving the soft palate, pharynx, and base of the tongue. Inflammation can also extend into compartments of the head, neck, and chest, including the airway and lungs. The organism responsible for the acute tonsillitis is usually the causative organism of the abscess. PTA may involve several organisms (polymicrobial infection), but most often it is caused by streptococcal bacteria; it can also be caused by other organisms such as staphylococci and pneumococci.

Incidence and Prevalence: In the United States, the annual incidence of PTA is about 30 cases per 100,000 people, which includes approximately 45,000 new cases per year (Gosselin). It is the most common infective disorder of the head and neck (Galioto).

The international incidence of PTA is reported to be higher than in the United States due to higher rates of recurrence and antibiotic resistance (Mehta).

Source: Medical Disability Advisor



Diagnosis

History: Individuals report recent acute tonsillitis with increasing discomfort. A history of chronic tonsillitis may also be reported. Symptoms may include a sore throat (especially when swallowing), facial swelling, drooling, difficulty and pain when opening the mouth and swallowing, swollen lymph nodes in the neck with neck pain and immobility, and referred ear pain, as well as headache, fever, fatigue, and malaise.

Physical exam: Examination of the throat reveals redness (erythema) and swelling (edema) of the tonsils and surrounding tissues, indicating a marked inflammatory process. One or both tonsils (bilateral) may be enlarged, with unilateral swelling of the peritonsillar tissue and soft palate. The uvula may be swollen and displaced to the unaffected side of the throat. The collection of pus that forms the abscess may be directly observed. The floor of the mouth and the pharyngeal wall may be inflamed. Lymph nodes in the neck are swollen and tender. Dehydration may be noted if the individual has not had sufficient fluid intake because of difficulty swallowing.

Tests: An aspiration of the abscess can confirm diagnosis by accurately localizing the abscess cavity. The aspirated fluid can be cultured to identify the causative organism and to help determine appropriate antibiotic therapy. A throat culture may be done to check for a streptococcal infection (i.e., strep throat). A blood culture may also be done to ensure that the infection is not systemic. A complete blood count (CBC) may be done to evaluate overall health status and to determine the white blood cell count (WBC), which indicates the body's immune response to the infection. An x-ray of the neck may be ordered to rule out other diagnoses. Intraoral ultrasound is sometimes used as a noninvasive and more definitive way to examine tissue and distinguish between cellulitis and a PTA. Also, a contrast-enhanced CT scan may be done to visualize an abscess located within the tonsil itself.

An individual with tonsillitis and bilateral swelling of lymph glands may be tested for heterophile antibodies to rule out infectious mononucleosis. A positive test for mono will require liver function tests.

Source: Medical Disability Advisor



Treatment

The infection must be treated with antibiotics. High-dose intravenous penicillin is often begun as an immediate treatment until the causative organism is identified and antibiotic sensitivity is determined. In addition to antibiotic therapy, steroids are sometimes used to reduce symptoms and speed recovery (Galioto). Dehydrated individuals may require intravenous fluids until swallowing returns to normal. Pain relievers (analgesics) may be given to reduce fever and relieve throat pain.

Aspiration of PTA is both diagnostic and therapeutic; the removal of accumulated purulent material and fluid is sometimes the only treatment required along with antibiotic therapy. However, the abscess itself usually requires surgical incision and drainage (I & D), in the majority of cases performed with a tonsillectomy.

Because peritonsillar abscesses tend to recur, a tonsillectomy is often recommended when the infection is cleared, usually about 6 weeks after the abscess was treated. In some cases, an immediate tonsillectomy is performed in order both to drain the abscess and prevent recurrence (Quinsy tonsillectomy) and to prevent airway obstruction. If breathing is compromised and airway obstruction is suspected, an anesthesiologist is usually consulted and may pass a tube into the airway (endotracheal intubation) to restore breathing.

Source: Medical Disability Advisor



Prognosis

Incision and drainage of PTA can provide rapid pain relief and, in conjunction with antibiotic therapy, effectively address the infection. An individual with uncomplicated PTA can expect full recovery in a relatively short period of time. However, because a PTA tends to recur, the tonsils are usually removed (tonsillectomy) after abscess healing is complete.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Otolaryngologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications may include cellulitis of the jaw, neck, or chest. The underlying infection may spread into spaces in the neck and chest, the lining of the lungs, or the heart. Pus may be aspirated into the lungs, causing pneumonia. If the inflammatory process spreads into fascial compartments of the head and neck, it may lead to airway obstruction. If swelling of infected tissue pushes the tongue upward and backward in the throat, the individual's ability to breathe may be compromised, and evaluation for airway obstruction may indicate the need for intubation or emergency tonsillectomy.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors include age of the individual, size and location of the abscess, causative organism, extent of infection, length of time before treatment was sought, method of and response to treatment, underlying chronic medical conditions, or presence of complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Uncomplicated cases of PTA generally do not require work restrictions, although talking and swallowing may be difficult until the swelling and pain subside.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have an episode of tonsillitis?
  • Did individual have difficulty talking or swallowing?
  • On examination, were the tonsils and surrounding tissues inflamed and swollen?
  • Was any pus observed?
  • Was PTA diagnosis confirmed by aspirating infected fluid?
  • Were the lymph nodes in the neck swollen and tender?
  • Were any other areas of mouth or throat inflamed and swollen? Was breathing compromised?
  • Were a throat culture and CBC done? Was a blood culture done?
  • Was the causative bacterial organism identified and antibiotic sensitivity determined?
  • Was an x-ray of the neck done? Intraoral ultrasound? CT scan?
  • Was a mono test done? If positive, were liver function tests performed?

Regarding treatment:

  • Was abscess drained?
  • Did individual receive the appropriate antibiotics?
  • Were steroids prescribed?
  • Was intubation required to overcome airway obstruction?
  • Did individual have an immediate tonsillectomy? Was a later tonsillectomy advised?

Regarding prognosis:

  • Does individual have an underlying condition that may impair ability to heal or impair recovery from infection?
  • Has individual had any complications?

Source: Medical Disability Advisor



References

Cited

Galioto, Nicholas J. "Peritonsillar Abscess." American Academy of Family Physicians 72 2 (2008): 199-201.

Gosselin, Benoit J. "Peritonsillar Abscess." eMedicine. Ed. Brian James Daley. 16 Aug. 2008. Medscape. 19 Jun. 2009 <http://emedicine.medscape.com/article/194863-overview>.

Mehta, Ninfa, et al. "Peritonsillar Abscess." eMedicine. Eds. Michael Glick, et al. 11 Mar. 2009. Medscape. 19 Jun. 2009 <http://emedicine.medscape.com/article/764188-overview>.

Source: Medical Disability Advisor