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.

Labyrinthitis


Related Terms

  • Bacterial Labyrinthitis
  • Inner Ear Infection
  • Labyrinthine Inflammation
  • Otitis Interna
  • Purulent Labyrinthitis
  • Serous Labyrinthitis
  • Sudden Sensorineural Hearing Loss
  • Suppurative Labyrinthitis
  • Vestibular Neuritis
  • Vestibulitis
  • Viral labyrinthitis

Differential Diagnosis

Specialists

  • Infectious Disease Internist
  • Internal Medicine Physician
  • Neurologist
  • Otolaryngologist

Comorbid Conditions

  • AIDS
  • Leg or back injury

Factors Influencing Duration

Length of disability is influenced by the underlying cause of the disease; the timeliness of intervention; and the severity of symptoms such as vertigo, nystagmus, or tinnitus. If hearing loss occurs, the individual's response to treatment or need for hearing aids may determine his or her ability to resume work tasks.

Medical Codes

ICD-9-CM:
386.3 - Labyrinthitis
386.30 - Labyrinthitis, Unspecified
386.31 - Labyrinthitis, Serous; Diffuse Labyrinthitis
386.32 - Labyrinthitis, Circumscribed; Focal Labyrinthitis
386.33 - Labyrinthitis, Suppurative; Purulent Labyrinthitis
386.34 - Labyrinthitis, Toxic
386.35 - Labyrinthitis, Viral

Overview

Labyrinthitis is an inflammation of the labyrinth, a system of interlocking, fluid-filled sacs and tubes in the canals of the inner ear that help maintain balance and control eye movements (vestibular system). The semicircular canals of the labyrinth become inflamed, disrupting their function. This syndrome may affect specific areas of the inner ear, including nerves that connect to the brain (neuronitis) or the spiral-shaped organ that responds to sound vibrations traveling through fluid (cochlea).

Two types of labyrinthitis have been identified: viral and bacterial.

Viral labyrinthitis typically causes sudden vertigo, balance loss, and impaired hearing. Fifteen percent of individuals with viral labyrinthitis exhibit positional vertigo (Strasnick). Viral labyrinthitis may originate from widespread (systemic) infections such as herpes or from diseases such as mononucleosis, German measles (rubella), measles (rubeola), polio, influenza, and hepatitis. This condition is also associated with hearing loss that may accompany AIDS.

Bacterial labyrinthitis, also known as purulent or suppurative labyrinthitis, is relatively rare but may cause fever, tinnitus, vertigo, nausea and vomiting, and various degrees of hearing loss (Oghalai). Ongoing (chronic) middle ear infections (otitis media) or upper respiratory infections (URI) are common causes that develop after a virus or bacteria invades the inner ear. Bacterial inflammation of the protective lining of the brain (bacterial meningitis) may also migrate to the inner ear. Injuries or disorders such as a tear in the membrane between the middle and inner ears (perilymphatic fistula) may also result in bacterial labyrinthitis.

This condition may also follow allergy, cholesteatoma, or ingestion of toxic drugs. Although symptoms are often the same, treatment depends on the cause of labyrinthitis.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Labyrinthitis tends to develop during middle age (Boston). Other risk factors include side effects from the use of prescription or nonprescription drugs (especially aspirin), stress, fatigue, ear trauma, a history of allergies that cause inflammation of the semicircular canals, smoking, or alcohol consumption (Hoch).

The onset of labyrinthitis is preceded by an upper respiratory tract infection up to 50% of the time (Boston).

Source: Medical Disability Advisor



Diagnosis

History: The individual may report symptoms of hearing loss in one ear; a sensation of spinning (vertigo), particularly when turning over in bed; and a loss of balance, notably falling toward the affected side. A history of recent middle ear infections (otitis media), upper respiratory infection (URI), or injury to the area may also be described. The individual may report a general feeling of illness (malaise), nausea and vomiting, fever, involuntary eye movements (nystagmus), and a sound like ringing in the ear (tinnitus).

Physical exam: The physical exam may be normal or may show signs of a URI. A neurological exam may show abnormal involuntary eye movements (nystagmus). A tuning fork may be used to test for possible hearing loss. The examiner will check the ear canal for inflammation, drainage, and an intact eardrum (tympanic membrane). Various maneuvers involving specific movements of the head may be conducted to see if symptoms such as vertigo or nystagmus can be duplicated, helping to identify the disease. Changes in the individual's position may also cause onset of nausea and malaise.

Tests: Hearing testing (audiometry) and other studies may be needed to determine any underlying disorder. If the ear is draining, a sample may be sent to the lab to identify (culture) the specific microorganisms that may be causing the infection. Blood or urine cultures may also be evaluated. A chest x-ray or examination of CSF may also be necessary. In certain cases, examining the interior structures in the head by MRI or CT scan may be required. A series of tests that measure eye movements (caloric stimulation test), dizziness associated with head movements, and responses to water circulating in the ear canal (electronystagmography) may be administered. Other tests may include an electroencephalogram (EEG) or evoked auditory potential studies.

Source: Medical Disability Advisor



Treatment

Antibiotics are prescribed if labyrinthitis results from a bacterial infection. Some antiviral medications may be useful if the condition is caused by viral infection. Antinausea drugs and sedatives or hypnotics help control symptoms and keep the individual calm and still during attacks of vertigo. Antihistamines may be given if the condition is allergy-related. Medication that blocks the action of the sympathetic nervous system (anticholinergics) may also be given. The individual may need to rest in bed for several days, taking in sufficient fluids to retain hydration. Individuals with chronic symptoms may be encouraged to move around as much as possible, however, to enable the brain to compensate for possible damage to the vestibular system.

In extreme cases, surgical intervention may be required, such as an incision in the eardrum to promote drainage of fluid (myringotomy) from the middle ear. A ventilation tube may also be inserted in the eardrum to equalize pressure in the ear. If permanent hearing loss occurs, a hearing aid may be required.

Source: Medical Disability Advisor



Prognosis

Spontaneous recovery is common within a few days to weeks, but the condition may recur. A return to normal function depends on the speed and efficacy of treatment as well as the source of the condition. Severe symptoms of vertigo usually pass within a few days to up to 3 weeks (Hain), but feelings of imbalance may persist for several weeks or even months, particularly with quick movements. Once symptoms of labyrinthitis have resolved, the individual's risk of falling returns to normal. In some cases, inflammation may cause severe damage within the labyrinth, resulting in permanent hearing loss. Even when permanent damage occurs, the brain may be able to adapt well enough to resolve symptoms in a period of days or months.

The prevalence of sudden sensorineural hearing loss from labyrinthitis is 10 in 100,000 individuals (Strasnick).

If a tiny incision in the eardrum (myringotomy) is needed to relive pressure from fluid buildup in the ear, or if insertion of a tube in the eardrum (myringotomy tube) is required to correct the condition, the outcome is usually very good, and complete healing occurs, with improved hearing within a month. In rare cases, complications of the surgery may include bleeding, infection, or hearing loss.

Source: Medical Disability Advisor



Rehabilitation

In some cases of labyrinthitis, individuals with permanent damage may be required to move around after the initial onset of symptoms to encourage the brain to adapt and restore balance. Activity may be needed for a period of days, weeks, or months, depending on the severity of the initial condition.

Source: Medical Disability Advisor



Complications

Labyrinthitis can result from or cause meningitis. Rarely, the inflammation can spread into other areas of the ear or the brain. Permanent hearing loss is possible on the affected side. Viral sources of labyrinthitis, such as hepatitis, may fail to resolve and cause ongoing symptoms. Labyrinthitis causing vertigo may result in imbalance and increase the risk of falling.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Hazardous activities should be avoided until 1 week after symptoms disappear. Depending on the nature of the individual's job, accommodations such as amplification may be necessary when permanent hearing loss occurs. If the individual experiences ongoing or recurrent symptoms such as dizziness, job tasks requiring good balance or sudden changes in position may need to be re-evaluated. Continuing symptoms of dizziness may also mean that the individual is unable to drive. If the individual has had a tube inserted in the eardrum, care must be taken to ensure no water gets into the ear canal. Use of prescribed medications for management of dizziness and/or nausea and vomiting may require review of drug policies. Safety issues may 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:

  • What is the cause of individual's labyrinthitis? Is it viral or bacterial?
  • Has individual suffered from allergy, cholesteatoma, ingestion of toxic drugs, chronic otitis media, URI, bacterial meningitis, or injury?
  • Has individual had a recent viral illness?
  • Does individual take aspirin?
  • Are other risk factors involved, such as stress, fatigue, a history of allergies that cause inner ear swelling, smoking, or alcohol consumption?
  • Does individual have hearing loss? Vertigo? Any other symptoms, such as malaise, fever, nausea and vomiting, nystagmus, or tinnitus?
  • Has individual received adequate testing (hearing, blood or urine cultures, x-ray, CT, MRI, caloric stimulation test, electronystagmography, EEG, or evoked auditory potential studies) to establish the diagnosis?
  • Have other conditions, such as vertigo, trauma to the inner ear, cardiovascular disease, allergies, neurological disorders, Ménière's disease, superior semicircular canal dehiscence, panic attacks or other anxiety disorders, migraine headache, stroke, multiple sclerosis, middle ear infection (otitis media), vestibular neuronitis, subarachnoid hemorrhage, brainstem tumor, and side effects from certain prescription and illegal drugs, been ruled out?

Regarding treatment:

  • Has individual received appropriate treatment, such as antibiotics, antiviral medications, antinausea drugs, sedatives, or hypnotics?
  • Was surgery (myringotomy or ventilation tube) necessary?
  • Has individual had a spontaneous recovery? Is this episode a recurrence?
  • Was rehabilitation necessary?

Regarding prognosis:

  • Are other conditions present, such as leg or back injuries or immune system disorders, that may affect recovery?
  • If surgery was performed, did individual experience any complications?

Source: Medical Disability Advisor



References

Cited

Boston, Mark E., and Barry Strasnick. "Inner Ear, Labyrinthitis." eMedicine. Eds. Michael E. Hoffer, et al. 6 Mar. 2008. Medscape. 17 Jul. 2009 <http://emedicine.medscape.com/article/856215-overview>.

Charles, J. , S. Fahridin, and H. Britt. "Vertiginous Syndrome." Australian Family Physician 37 5 (2008): 299. PubMed. <PMID: 18464956>.

Hain, T. C. "Vestibular Neuritis and Labyrinthitis." American Hearing Research Foundation. Oct. 2008. 17 Jul. 2009 <http://www.american-hearing.org/disorders/unilat/vestibular_neuritis.html>.

Hoch, Daniel B., and David Zieve. "Labyrinthitis." MedlinePlus. 27 Sep. 2008. National Library of Medicine. 10 Aug. 2009 <http://www.nlm.nih.gov/medlineplus/ency/article/001054.htm>.

Oghalai, J. S. "Purulent Labyrinthisis." The Merck Manuals. 17 Jul. 2007. Merck & Co., Inc. 1 Jul. 2009 <http://www.merck.com/mmpe/print/sec08/ch086/ch086g.html>.

Strasnick, Barry, et al. "Labyrinthitis and Related Conditions." eMedicine. Eds. Spiros Manolidis, et al. 10 Apr. 2008. Medscape. 17 Jul. 2009 <http://emedicine.medscape.com/article/1159264-overview>.

Source: Medical Disability Advisor






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