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.

Dizziness and Giddiness


Related Terms

  • Dysequilibrium
  • Faintness
  • Lightheadedness
  • Spinning
  • Vertigo

Differential Diagnosis

Specialists

  • Internal Medicine Physician
  • Neurologist
  • Otolaryngologist

Comorbid Conditions

Factors Influencing Duration

Duration depends on the cause of the dizziness and the individual's response to treatment.

Medical Codes

ICD-9-CM:
780.4 - Dizziness and Giddiness; Light-headedness; Vertigo NOS

Overview

Dizziness is a term that is used to explain different sensations, such as lightheadedness and spinning (vertigo) accompanied by an involuntary, rapid, rhythmic eye movement (nystagmus); giddiness; and feeling as if one is going to faint (syncope). Without other symptoms, this condition usually is not serious.

There are many causes for dizziness and giddiness. Decrease in circulating blood and oxygen to the brain can cause dizziness and fainting. Irregular heart rate or rhythm (dysrhythmia) can result in a sudden reduction in the amount of blood pumped to the brain and can cause dizziness. Temporary deficiency of blood in the brain secondary to narrowing of the arteries in the brain (cerebral transient ischemic attack, or TIA) also can result in dizziness. Sudden change in position from sitting or lying to standing can cause a drop in blood pressure (orthostatic or postural hypotension) and dizziness. Dizziness can result from taking medications such as vasodilators, decongestants, antidepressants, antihypertensives, antihistamines, or diuretics; from anemia due to blood loss; and from decreased blood volume or fluid loss from trauma or sweating (dehydration). When lightheaded dizziness leads to syncope or loss of consciousness, problems with blood circulation (heart, blood vessels, and problems that affect their function) must be checked. Dizziness also may occur with diabetes mellitus, multiple sclerosis, and Parkinson's disease.

Disorders involving the balance organs in the ear resulting from infection or inflammation of the inner ear (labyrinthitis), inner ear fluid imbalance (Ménière's disease), viral infection of the vestibular nerve (vestibular neuronitis), and inner ear fluid leaking into the middle ear can cause individuals to feel dizzy or unsteady; ringing in the ears (tinnitus) also can develop. Double vision (diplopia) is a more serious symptom that may indicate a disease affecting the brainstem, warning of a serious stroke, or other disease processes. Slurred speech (dysarthria) that accompanies dizziness and vertigo points to a process affecting the brain itself (e.g., a stroke, brain tumor).

Other causes of dizziness include anxiety, stress, fatigue, high fever, strenuous coughing, straining with defecation or urination, stomach flu (gastroenteritis), common cold, pressure on the neck (e.g., tight collar), spinning rapidly around in a circle (as during carnival rides), low blood pressure (hypotension), severe pain, injury, fright, standing rigidly at attention for an extended period, alcohol intoxication, use of illicit drugs, hyperventilation, low blood glucose (hypoglycemia), perforated eardrum (tympanic membrane), ear diseases (i.e., mastoiditis, otitis media, cholesteatoma, vestibular neuronitis), and hysterical seizures.

Incidence and Prevalence: Incidence of dizziness, vertigo, and imbalance is 5% to 10% in the general population (Friedman). Annual incidence of BPPV is 64 per 100,000 population (Chang). Prevalence of dizziness caused by fluid disturbances in the inner ear (e.g., Ménière's disease) is 1,000 per 100,000 population (Li). In cases of acute vertigo, 170 cases per 100,000 population are caused by vestibular neuronitis (Friedman). Dizziness caused by a tumor on cranial nerve VIII (acoustic neuroma) is less common, affecting 1.1 per 100,000 population (Friedman).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Susceptibility to dizziness and giddiness increases with age, affecting 40% of individuals aged 40 and over (Friedman). Women are 1.8 to 2.0 times more likely to experience dizziness than men (Chang, Friedman). One-quarter of individuals with migraine headaches and one-third of individuals with multiple sclerosis experience dizziness (Friedman). With individuals experiencing an acute onset of dizziness, 25% to 40% is caused by benign paroxysmal positional vertigo (BPPV), a problem caused by the movement of calcium crystals (canaliths or otoliths) in the inner ear (Chang).

Source: Medical Disability Advisor



Diagnosis

History: The individual will be questioned in detail as to when dizziness occurs, the nature of the dizziness, how long the spells last, other concurrent symptoms, and a history of other disease processes. The individual may complain of lightheadedness, spinning (vertigo), fainting (syncope), unsteadiness, a tilting sensation, motion intolerance, and the sense that surrounding noises are growing fainter and fainter. Sometimes other symptoms such as nausea, vomiting, visual blurring, tinnitus, sweating, generalized discomfort, headache, weakness, and disorientation are reported to accompany dizziness.

Physical exam: Upon examination, the physician may detect problems with vision, hearing, sensitivity to noise or bright light (photophobia), ability to think (cognition), or memory. The individual may be disoriented and sweat profusely. Rapid, involuntary eye movements (nystagmus) may be present. Blood pressure may be low or may change dramatically after the individual moves from a lying down to standing. The vestibular evaluation includes vigorous head shaking in the horizontal plane for about 10 seconds, and a positioning test (Dix-Hallpike maneuver).

Tests: The underlying cause for dizziness may be determined by positional testing using Frenzel lenses. Other tests that may be used are a check for abnormal eye movements (electronystagmogram, or ENG) that includes placing warm water in the ear canal (caloric test), rotating chair test, posturogram (a test where the individual stands on a platform and body sway is recorded in response to the movement of the platform), audiogram to identify sensorineural hearing loss resulting from nerve damage, imaging studies of the head and neck (CT scan, MRI), carotid Doppler studies or angiogram to identify narrowing or other abnormality in the carotid artery (main artery to the brain), electrocardiogram (ECG), chest x-ray, echocardiogram, wearing a Holter monitor to assess cardiac function, and psychological tests to evaluate stress and identify anxiety and panic disorders and their triggers.

Source: Medical Disability Advisor



Treatment

Treatment for dizziness is based on its underlying cause and may consist of bed rest and taking medications such as antihistamines, vestibular suppressants, medications to lessen nausea, centrally acting anticholinergics, antibiotics, antiviral medications, corticosteroids, or medications affecting the GABA (gamma-aminobutyric acid) receptors.

Dietary changes and reducing alcohol, caffeine, and nicotine intake may be helpful in the treatment of dizziness. Regular exercise, moving slowly and deliberately, and taking good care of general health are also important in treating this problem.

Orthostatic hypotension is treated by educating individuals to be cautious about rising suddenly from bed or from sitting, instructing them to exercise their legs and having them sit at the edge of the bed briefly before standing to make sure they do not feel lightheaded.

In some cases, vertigo may be treated with vestibular rehabilitation therapy, where the individual is instructed to perform individualized head, neck, and body movements that assist brain compensation. Benign paroxysmal positional vertigo (BPPV) is treated with canalith repositioning maneuvers (Epley maneuver) to move canaliths within the semicircular canals of the inner ear ("Vertigo").

If medical management is not effective, surgery may be indicated. A variety of inner ear surgical procedures can be done to correct dizziness if the condition is due to a balance disorder. These include the removal of the interconnecting cavities/canals (labyrinth) that constitute the inner ear (labyrinthectomy), cutting the balance nerve (selective vestibular neurectomy), or placing a shunt within the labyrinth (endolymphatic shunt).

Source: Medical Disability Advisor



Prognosis

In most cases individuals recover fully. If dizziness is due to an underlying disease, prognosis will depend on the disease, its severity, and how effectively it can be treated. Attacks of dizziness are controlled in up to 81% of individuals who have the endolymphatic shunt (“Endolymphatic Shunt”). Recovery from this procedure is short compared to other procedures, although the affected ear may protrude for up to 3 weeks, and ear numbness may last for several months; hearing loss occurs in 0.5% of cases (“Endolymphatic Shunt”).

Attacks of dizziness are permanently cured for a high percentage (95%) of individuals after selective vestibular neurectomy (Hain). Labyrinthectomy also results in a high cure rate for dizziness (about 85%) (De La Cruz).

Source: Medical Disability Advisor



Complications

Complications include trauma associated with falls that are due to fainting or loss of balance. An underlying disease process may have associated complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations may depend on the job the individual performs. Operating machinery, driving a motor vehicle, and handling hazardous objects pose a safety concern. Use of prescribed medications for management of dizziness may require review of company drug policies. Safety issues need to be evaluated.

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:

  • Does individual have orthostatic hypotension? Adverse side effects from prescription medication? Anemia? Dehydration?
  • Does individual have TIAs or history of stroke?
  • Does individual have any heart problems, diabetes, Parkinson's disease, multiple sclerosis?
  • Are there disorders of any part of the ear? Does individual have tinnitus?
  • Has individual had a head injury?
  • Does individual have double vision or slurred speech?
  • Does individual exhibit anxiety, stress, fatigue, fever, or strenuous coughing?
  • Has there been straining with defecation or urination, gastroenteritis, common cold, pressure on the neck, or spinning rapidly around in a circle?
  • Does individual experience severe pain, injury, fright, or is required standing rigidly at attention?
  • Are there signs of alcohol intoxication? Illicit drug use? Hyperventilation? Hypoglycemia?
  • Were a caloric test, ENG, CT, MRI, position test, and posturogram done?
  • Were an audiogram, carotid angiogram, and Doppler studies performed?
  • Has individual had an ECG, chest x-ray, echocardiogram, Holter monitor?
  • Was psychological testing done? What were the results?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Have underlying conditions causing the dizziness been identified and treated?
  • Has individual been on medications? Were they helpful? Is surgery indicated?
  • Has individual made necessary dietary changes such as reducing alcohol, caffeine, and nicotine intake and eliminating illicit drug use?
  • Does individual exercise regularly? Take good care of health?

Regarding prognosis:

  • Has individual undergone vestibular rehabilitation with a trained professional?
  • Does individual have any conditions that may affect ability to recover?
  • Has individual experienced trauma associated with falls due to fainting or loss of balance or other complications that may delay recovery?
  • Can individual's employer accommodate any necessary restrictions?

Source: Medical Disability Advisor



References

Cited

Chang, A. K. "Benign Paroxysmal Positional Vertigo." eMedicine. Eds. Edward Bessman, et al. 6 Jul. 2007. Medscape. 13 Aug. 2009 <http://emedicine.medscape.com/article/791414-overview>.

De La Cruz, A., K. Teufert, and K. I. Berliner. "Transmastoid Labyrinthectomy Versus Translabyrinthine Vestibular Nerve Section: Does Cutting the Vestibular Nerve Make a Difference in Outcome? " Otology & Neurology 28 6 (2007): 801-808. PubMed. <PMID: 17948358>.

Hain, T. C. "Vestibular Nerve Section." Dizziness-and-Balance. 10 Nov. 2008. 15 Jul. 2009 <http://www.dizziness-and-balance.com/treatment/vn_section.html>.

Laberge, Monique. "Endolymphatic Shunt." Encyclopedia of Surgery. 2007. Advameg, Inc. 13 Aug. 2009 <http://www.surgeryencyclopedia.com/Ce-Fi/Endolymphatic-Shunt.html>.

Li, John, and Nicholas Lorenzo. "Endolymphatic Hydrops." eMedicine. Eds. Spiros Manolidis, et al. 12 Mar. 2009. Medscape. 15 Jul. 2009 <http://emedicine.medscape.com/article/1159069-overview>.

Samy, Hesham M., and Mohamed Hamid. "Dizziness, Vertigo, and Imbalance." eMedicine. Eds. Spiros Manolidis, et al. 2 Aug. 2009. Medscape. 13 Aug. 2009 <http://emedicine.medscape.com/article/1159385-overview>.

General

"Vertigo (Dizziness)." Neurology Channel. 29 May. 2008. Healthcommunities.com. 15 Jul. 2009 <http://www.neurologychannel.com/vertigo/index.shtml>>.

Source: Medical Disability Advisor






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