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.

Laryngectomy


Related Terms

  • Surgical Removal of Larynx

Specialists

  • Otolaryngologist

Comorbid Conditions

  • Chronic obstructive pulmonary disease (COPD)
  • Metastasis of primary throat cancer
  • Obesity

Factors Influencing Duration

Duration of disability may be influenced by the underlying disease necessitating the laryngectomy. The individual may require more time in the hospital if there are complications following surgery. A prolonged period of time may be needed for speech rehabilitation and rehabilitation to resolve difficulties with swallowing.

Medical Codes

ICD-9-CM:
30.0 - Excision or Destruction of Lesion or Tissue of Larynx
30.09 - Excision or Destruction of Lesion or Tissue of Larynx, Other; Stripping of Vocal Cords
30.1 - Hemilaryngectomy
30.2 - Partial Laryngectomy, Other
30.29 - Partial Laryngectomy, Other; Excision of Laryngeal Cartilage
30.3 - Complete Laryngectomy; Block Dissection of Larynx (with Thyroidectomy) (with Synchronous Tracheostomy); Laryngopharyngectomy
30.4 - Radical Laryngectomy; Complete [Total] Laryngectomy with Radical Neck Dissection (with Thyroidectomy) (with Synchronous Tracheostomy)

Overview

© Reed Group
A laryngectomy is the surgical removal of the larynx. The larynx is the organ in the throat that contains the vocal cords, guards the airway into the lungs (trachea) during swallowing, and maintains an open airway.

The larynx is divided into several different structures. In some cases, a partial laryngectomy may be performed, removing only the diseased portions (such as removing only one vocal cord) of the larynx. The ability to speak may remain following partial laryngectomy, although the voice may be altered. In most cases, the entire larynx is removed, and a procedure to install an artificial airway (tracheostomy) may be performed simultaneously.

Source: Medical Disability Advisor



Reason for Procedure

A laryngectomy is performed when the individual has throat cancer, typically squamous cell carcinoma, which has not responded to radiation treatment.

Source: Medical Disability Advisor



How Procedure is Performed

The individual is positioned on the operating table lying on the back with the neck extended. The patient is intubated, and general anesthesia is induced. The neck region is cleansed with a surgical scrub solution, and surgical drapes are positioned over the rest of the body. An incision is made, and the area is exposed. Structures around the larynx (such as muscles, nerves, vessels, thyroid gland) are identified and separated from surrounding tissues. The endotracheal tube that is placed for anesthesia is removed so that an incision can be made into the trachea. A different breathing tube is then placed into the lower part of the trachea. The surgeon then separates the larynx from the upper part of the airway (pharynx). The larynx and tumor can then be totally removed. A tube that will be used for feeding is inserted through the nose down through the back of the throat into the esophagus. The size (diameter) of the hole that has been made for breathing (tracheal stoma) is adjusted, and drains are placed into the wound. Either a tracheostomy or laryngectomy tube may be placed into the tracheal stoma to aid breathing and keep the airway open following surgery.

Source: Medical Disability Advisor



Prognosis

Complete removal of the malignancy is often the outcome of laryngectomy. The 5-year survival rate is 90% following surgical removal or radiation therapy of early-stage cancers that have not spread to nearby structures from the primary (original) site. The outcome of more advanced cancer and more extensive surgeries may vary and may include chemotherapy and radiation. The outcome for laryngectomy includes an open (patent), healed stoma, through which the individual can easily breathe and clear secretions from the lungs. To aid breathing and keep the stoma open, a laryngectomy or tracheostomy tube will be necessary for several months until the stoma is completely healed.

Source: Medical Disability Advisor



Rehabilitation

Speech therapy is necessary for learning new methods of speaking. In total laryngectomy, speech may be enabled in one of three methods: by using air that has been pulled into the esophagus (esophageal speech); by surgical creation of a tracheoesophageal fistula (also known as tracheoesophageal puncture), which is placement of a one-way valve into an opening between the trachea and esophagus for speech; or by use of a device that is held against the throat for speech (electric larynx).

The individual may not be able to swallow food correctly until healing is completed. A tube placed through the nose, down the esophagus, and into the stomach (nasogastric tube) may be necessary for liquid tube feedings for several days or weeks. For laryngectomy without extensive surgery to the neck and esophagus (radical neck surgery), oral nutrition is often possible. With partial laryngectomy, swallowing difficulties may occur, requiring rehabilitation. Therapy may be necessary to ensure that food that is swallowed flows into the stomach and not into the lungs.

Source: Medical Disability Advisor



Complications

Several complications can occur with a laryngectomy, including hemorrhage, airway obstruction (which may be due to tissue swelling or accumulation of secretions), infection, rupture of the carotid artery, fistula formation, narrowing of the tracheostomy (tracheostomy stenosis), and nerve injury. With partial laryngectomy, there may be difficulty swallowing and potential aspiration of gastric contents.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Time off from work will be needed for surgery, complete recovery, and rehabilitation. Further time off from work may be needed for additional cancer treatments, such as chemotherapy and radiation therapy. Learning to care for the tracheostomy tube and tracheal stoma may require time off from work. Temporary accommodations may be necessary for individuals whose jobs require oral communication. Until the stoma is well healed, laryngectomy and tracheostomy tubes may require care during the work shift, necessitating additional break time. With total laryngectomy and loss of voice, job reassignment may be needed, either temporarily or permanently.

Source: Medical Disability Advisor



References

General

Willsie, Sandra K. "Cancers of the Larynx and Lung." Saunders Manual of Medical Practice. Ed. Robert E. Rakel. 2nd ed. Philadelphia: W.B. Saunders, 2000. 237-239.

Source: Medical Disability Advisor






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