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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.

Nasal Septal Perforation


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
478.19 - Disease of Nasal Cavity and Sinuses, Other

Related Terms

  • Perforated Nasal Septum

Overview

Nasal septal perforation refers to a hole that has eroded the central cartilage (septum) between the nostrils. Repeated injury to the septum or conditions that affect the tissue in this area can result in perforation.

Nasal septal perforation has many causes, including cocaine abuse, chemical insult, septal surgery, trauma, and habitual nose picking. Diseases that can cause nasal perforation include syphilis, tuberculosis, sarcoidosis, cancer, and Wegner's granulomatosis (a rare condition affecting the nasal tract). Perforation can cause nasal congestion, nasal drainage, and recurrent nosebleeds.

Incidence and Prevalence: Nasal septum perforation is uncommon, but the exact incidence is unknown.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Lifestyle choices such as cocaine use, inhalation of recreational chemicals, smoking, and alcohol abuse put individuals at increase risk of developing a nasal perforation. Individuals who are exposed to industrial chemicals, especially chromic acid, also are at higher risk of developing a nasal septum perforation.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of new or recurrent nosebleeds that are spontaneous or caused by a specific incident. Bleeding can be severe or mild. Excess nasal crusting and dryness of the nasal passages is possible. Some perforations can result in an annoying nasal whistling sound that causes the individual to seek treatment. An underlying disease may cause other symptoms to manifest.

Physical exam: The exam may reveal a hole in the nasal septum, tissue that develops on the surface of an open wound during the healing process (granulations), and crusting.

Tests: Examination of the nose using anterior rhinoscopy or nasal endoscopy indicates the extent and location of the perforation.

Laboratory evaluation for anemia and toxicology may be indicated. Typical tests include urinalysis (drug screening to rule out cocaine use), complete blood count (CBC), erythrocyte sedimentation rate (ESR), antineutrophilic cytoplasmic antibodies (ANCA, to rule out granulomatous diseases), and evaluation for syphilis.

A CT may be used to examine the sinuses if granulomatous disease is suspected. If there is evidence of lung disease, a chest x-ray may help to diagnose tuberculosis or sarcoidosis. Cultures and biopsy of the septal tissue may be helpful in identifying fungal or bacterial infections.

Source: Medical Disability Advisor



Treatment

Habitual nose picking should be eliminated. Proper treatment of granulomatous diseases with corticosteroids enables healing. If an infectious disease such as tuberculosis or syphilis is the cause, proper treatment should be sought to eliminate the infection. Perforation due to cocaine abuse necessitates drug rehabilitation and counseling.

Septal perforations are surgically repaired only if complicated by persistent nosebleeds, crusting that causes nasal obstruction, or, rarely, a whistling sound produced by air passing through the perforation. Smaller perforations are more easily repaired surgically. Mucosal flap closure is the most common method of repairing a septal perforation. This involves creating a small flap out of the skin on the inside of the nose to cover the hole. Large perforations are often not repaired, and some are even enlarged to reduce the symptoms of the perforation.

Source: Medical Disability Advisor



Prognosis

The perforated septum usually heals with correction of the underlying cause, such as treatment of granulomatous disease or infectious disease. Removal of chronic irritation from cocaine abuse also allows the septum to heal. Surgical repair with mucosal flap closure yields better results with smaller perforations. Large perforations may not be repaired and may never heal.

Individuals recovering from surgery may find breathing through the nose difficult until the swelling following surgery subsides. During this time, forceful nose blowing and insertion of objects or fingers into the nose should be avoided.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Internal Medicine Physician
  • Otolaryngologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Persistent and profuse nosebleeds may complicate nasal septum perforation.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability may be influenced by the severity of the perforation, the underlying cause, the individual's response to treatment, or any complications. Nasal infections after surgery can impair healing. Continued cocaine abuse or habitual nose picking also lengthens disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not usually associated with this condition. Individuals may need to adjust their duties to avoid exposure to chemical fumes and smoke. Individuals whose jobs require large amounts of talking, such as sales reps or telephone operators, may find their job difficult after surgery due to the nasal quality of the voice. This problem should resolve quickly.

Risk: While it is often difficult to identify where the exposure to irritants occurs, some occupations, such as chromium electroplating, bring an increased risk to the workers (Melhorn, 552-554).

Capacity: Capacity should not be affected with nasal septal perforation.

Tolerance: Tolerance should not be affected by nasal septal perforation.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

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 a history that places him/her at risk for perforated septum (trauma to nasal septum, cocaine use, tuberculosis, or granulomatosis, etc.)?
  • Did individual present with symptoms such as new or recurrent nosebleeds, nasal crusting, and nasal whistling?
  • Did physical exam confirm the diagnosis?
  • Was the underlying cause of the perforation determined?
  • Were other conditions with similar symptoms or associated conditions (bleeding disorders, hypertension, nasal tumor or trauma) ruled out?

Regarding treatment:

  • Was treatment appropriately directed at correcting the underlying cause (eliminating habitual nose picking or cocaine use, treating underlying granuloma)?
  • Did the perforation warrant surgical intervention?

Regarding prognosis:

  • Does individual have an underlying condition, such as diabetes, immune disorders, allergies, or sinus infection that may impair healing and prolong recovery?
  • Does individual continue to have persistent and profuse nosebleeds? If so, has the individual been compliant with treatment recommendations?
  • If cocaine abuse is a problem, has behavioral counseling been considered?

Source: Medical Disability Advisor



References

Cited

Lanier, B., et al. "Pathophysiology and Progression of Nasal Septal Perforation." Annals of Allergy, Asthma & Immunology 99 (2007): 473-479.

Williams, N. "What Are the Causes of a Perforated Nasal Septum?" Occupational Medicine (London) 50 (2000): 135-136.

General

Batniji, Rami K. "Septal Perforation: Medical Aspects." eMedicine. Eds. Arlen D. Meyers, et al. 30 Sep. 2013. Medscape. 27 Oct. 2014 <http://emedicine.medscape.com/article/863325-overview>.

Source: Medical Disability Advisor