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.

Deviated Nasal Septum


Related Terms

  • Crooked Septum
  • Deviated Septum
  • Nasal Obstruction

Differential Diagnosis

  • Allergic rhinitis
  • Cocaine abuse
  • Head and neck deformities

Specialists

  • Otolaryngologist
  • Plastic Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that influence disability include the severity of breathing difficulties, other deformities of the nose or facial structures requiring additional correction, the type of treatment or surgical repair, and the individual's response to treatment. The presence of allergies or poor health status can delay healing after corrective surgery.

Medical Codes

ICD-9-CM:
470 - Deviated Nasal Septum

Overview

© Reed Group
A deviated nasal septum refers to a deformity of the partition in the nose that separates the two nostrils. Composed of bone and cartilage, this partition (nasal septum) is covered with a mucous membrane. The nasal septum usually is straight and reasonably centered, dividing the nasal passage into two equal halves. In some individuals, however, the septum is bent (deviated), a condition either present at birth (congenital) or, more commonly, the result of injury to the nose. The septum may be shifted severely from the midline so as to partially or completely block the nasal passage. There are two main types of deviation; one occurs when the more flexible cartilage of the lower end of the septum becomes dislocated and pushed to one side, narrowing one of the nostrils; the other type results when the septum deforms into an S-shape, causing a partial or complete blockage of both nostrils.

Blocking the nasal passage can interfere with sinus drainage, making the individual prone to sinus inflammation (sinusitis) and repeated infection (chronic sinusitis). Because excess airflow through the unblocked passage can dry the mucous membrane, the individual also may be prone to nosebleeds (epistaxis).

Incidence and Prevalence: Some degree of nasal passage obstruction is common. It is reported to occur in about one-third of the adult population, and deviated nasal septum is the most frequent deformity resulting in nasal obstruction that requires treatment (Watson). Actual incidence is not known because many individuals have a minor deviation that presents problems only during colds and is therefore not reported.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The most frequent cause of a deviated septum is accidental trauma to the nose. In approximately 5% of cases, septal deviation is a birth defect, with risk of developing further during maturation and causing nasal passage obstruction (Watson). Individuals who play contact sports such as karate or football without protective headgear are at higher risk. Not wearing a seatbelt increases risk of injury to the face or nose in the event of a high impact automobile accident.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report a history of injury to the nose or face. The most common symptom associated with a deviated septum is difficulty breathing. Depending on the severity of the obstruction, the individual may report chronic nasal congestion, sinusitis, repeated ear infections, headache, or nosebleeds. Scuba divers with a deviated septum may have difficulty equalizing the pressure in their ears when they dive.

Physical exam: Visual inspection may reveal an inequality in the size of the nostrils and/or a deformity in the septum. A deformity of the external nose sometimes is apparent. When there is a history of injury, the septal bending is usually toward the injured side. Examination of the nasal cavity may reveal blockage of one or both nostrils. Noisy breathing may be noted. Signs of chronic sinusitis or allergic rhinitis may be present, such as post-nasal drip, nasal inflammation, and swelling of nasal cavity walls. If irritation and swelling of the nasal mucosa are present, the physician may ascertain whether the individual has used nasal decongestant spray for a long period, has used cocaine, or has taken certain medications (e.g., beta-blockers, sympatholytics, hormone replacement therapy) (Watson). Food allergies may be addressed as well.

Tests: X-rays of the face and sinuses may be taken to confirm the nasal septal deviation and to evaluate for sinus infection.

Source: Medical Disability Advisor



Treatment

Mild forms of nasal septum deviation require no medical intervention other than treatment of occasional nasal congestion, sinusitis, or allergy symptoms: these may be treated with decongestants, antibiotics, or antihistamines and nasal inhaled steroids, respectively. A general practitioner should monitor long-term use of decongestants because misuse can cause rebound symptoms.

When the deviation is more severe and obstructs breathing, surgical intervention is necessary. A surgical procedure called septoplasty is performed under local or general anesthesia. With an endoscope, the surgeon makes an incision inside the nose, lifts up the lining of the septum, and realigns and/or removes the deviated portions of the septal bone and cartilage. The septum may be held in place with splints placed inside the nostrils. A submucous resection (SMR) is a more extensive resection of cartilage and bone, removing part of the flat bone from the inside and back of the nasal septum (vomer) and the ethmoid bone that defines the sinus above the septum, as well as correcting the deviated septum itself (Watson). The usual goal, however, is to leave as much supporting cartilage in the septum as possible.

Source: Medical Disability Advisor



Prognosis

Prognosis usually is good after either septoplasty or submucous resection. Normal breathing typically is restored and other symptoms resolve completely. Most individuals are up and about within a few days and can return to sedentary work in about 1 week. Swelling may be present for a few months after surgery.

Source: Medical Disability Advisor



Complications

A deviated nasal septum can interfere with normal drainage from the sinuses and result in recurrent sinus infections. Drainage of mucus from the middle ear also can be hindered by a deviated nasal septum and result in repeated ear infections or a condition called "glue ear."

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may need to avoid respiratory irritants (smoke and dust) for a short period.

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:

  • What is the cause of the deviated septum? Trauma? Birth defect?
  • If trauma-related, did additional injuries occur to the nose or surrounding area requiring additional treatment or correction, such as rhinoplasty?
  • Were other conditions noted or ruled out, including allergic rhinitis, mucosal edema, or irritation from long-term use of decongestant spray; or from cocaine abuse?

Regarding treatment:

  • How long were symptoms present prior to correction? How severe?
  • Have decongestants, antibiotics, or nasal inhaled steroids failed to satisfactorily treat individual?
  • If treated medically, was treatment palliative or curative?
  • Is septal surgery warranted?
  • Will additional treatment (surgical correction) be necessary in the future?

Regarding prognosis:

  • If surgical correction was required, what method was used? Septoplasty? Submucous resection?
  • Was successful correction accomplished? If not, what is being considered as future treatment? Rhinoplasty?
  • Do symptoms persist despite surgical correction?

Source: Medical Disability Advisor



References

Cited

Watson, Deborah. " Septoplasty." eMedicine. Eds. Gregory Branham, et al. 18 Mar. 2009. Medscape. 24 Jul. 2009 <http://emedicine.medscape.com/article/877677-overview>.

Source: Medical Disability Advisor






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