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.

Ménière's Disease


Medical Codes

ICD-9-CM:
386.00 - Ménières Disease; Unspecified; Ménières Disease, Active
386.01 - Active Ménières Disease, Cochleovestibular
386.02 - Active Ménières Disease, Cochlear
386.03 - Active Ménières Disease, Vestibular
386.04 - Inactive Ménières Disease; Ménières disease in remission

Related Terms

  • Cochlear Hydrops
  • Cochlear Ménière’s Disease
  • Idiopathic Endolymphatic Hydrops
  • Ménière’s Syndrome
  • Vestibular Ménière’s Disease

Overview

Ménière's disease is a recurrent (episodic) disease of the inner ear typically characterized by 4 classic symptoms: fluctuating hearing loss, a sense of pressure or fullness in the ear, low-tone ringing in the ear (tinnitus), and a sensation of spinning or movement (vertigo). Although there are many theories on why the disease occurs, the cause is unknown (idiopathic). Many experts believe that the disease results from endolymphatic fluid (1 of 2 inner ear fluids) leaking through a separating membrane into perilymphatic fluid (the other inner ear fluid); when the 2 fluids mix, symptoms result. Other experts believe that fluids within the inner ear fluctuate in pressure when the endolymphatic duct becomes blocked, causing the symptoms. Some believe the condition may be linked to factors such as injury, infection, herpes simplex virus, autoimmune disorders, genetics, or metabolic processes. Still others are investigating links between Ménière's disease and environmental factors, such as noise pollution. None of these theories have been scientifically proven.

There are 2 atypical types of Ménière's disease: In cochlear Ménière's disease (also called cochlear hydrops), symptoms involve fluctuating hearing loss, tinnitus, and a sense of pressure but no vertigo. In vestibular Ménière's disease (also called vestibular hydrops), symptoms include fluctuating vertigo, tinnitus, and a sense of fullness but no hearing loss. Some individuals who start out with one of these atypical forms will eventually develop the fourth symptom, and the disease then becomes classic Ménière's.

The condition is episodic, which means that attacks may be followed by symptom-free periods. Symptoms vary widely from person to person. Each episode (of vertigo, sense of pressure, tinnitus, or hearing loss) may last minutes or hours, hearing loss may be gradual or progressive, and tinnitus may sound different to different individuals. Some individuals have the condition in one ear, but it may or may not progress to both ears. Approximately 50% of individuals with the condition will eventually develop it in both ears (Hain).

Incidence and Prevalence: There are an estimated 615,000 individuals in the US with Ménière’s disease, and another 45,000 new cases are diagnosed each year ("Meniere’s Disease").
The prevalence of Ménière’s disease in the United Kingdom is 157 per 100,000 individuals (Wilkerson).

Source: Medical Disability Advisor



Diagnosis

History: In the initial stages of Ménière’s disease, the individual may first complain of fullness in the ear and/or tinnitus, and a loss of hearing, followed by vertigo. As symptoms progress, the vertigo may become debilitating, causing nausea, vomiting, and sweating, and forcing the individual to lie down. The symptoms may range in severity from a brief episode of impaired balance to an intense, extended illusion of spinning that can last several hours. The individual may describe tinnitus as the sound of roaring or buzzing in the ear. Symptoms typically subside completely after the attack, but the individual may report a continuing sense of unsteadiness and a deep sense of fatigue. Hearing loss may recover between attacks but worsen as time goes on. The attacks may occur at any time and waken the individual from sleep. Other symptoms may include headaches, abdominal pain, and diarrhea.

Physical exam: The exam is generally normal.

Tests: Hearing (audiometry) tests may be conducted to identify the extent and type of auditory losses associated with Ménière’s disease. The pattern of hearing loss is described as a low-frequency upsloping hearing loss of neural type. Test results in combination with other symptoms may help confirm the diagnosis. More detailed analysis includes measurements of the function of the auditory nerve (transtympanic electrocochleography) and other interior structures. An electronystagmography (ENT) test may be conducted to determine if something is wrong with the vestibular portion of the inner ear. Part of that procedure includes a caloric test, which produces rapid, involuntary eye movements (nystagmus) that help determine if there is a balance disorder. Brain stem–evoked response audiometry helps pinpoint the location within the nervous system of the hearing problem. Blood tests (serology) or imaging of the internal structures of the body (MRI) may be conducted to rule out other possible causes of symptoms, such as infections, tumors, or metabolic disorders.

Source: Medical Disability Advisor



Treatment

There is no cure for the condition. Because the fluids within the inner ear may be influenced by dietary intake, as a lifestyle measure individuals may be instructed to avoid foods high in salt and monosodium glutamate (MSG), and to drink adequate amounts of fluids on a consistent basis, taking care to increase fluid intake to combat exercise-induced fluid loss. Regular exercise may promote good circulation within the inner ear. Medications such as those aimed at reducing fluids in the body (diuretics) are usually given to help relieve fluctuations of fluids in the inner ear. Other medications may be prescribed to relieve symptoms of vertigo and accompanying nausea and vomiting. The individual may be advised to avoid consumption of caffeine, nicotine, and alcohol, which can cause symptoms to worsen. Sedatives may be prescribed to relieve severe anxiety caused by serious attacks. In rare instances, oral steroids help relieve underlying autoimmune disorders that may cause Ménière’s disease. Antibiotics may also be needed to treat possible underlying infections.

During an acute episode, the individual will be instructed to lie down and remain as motionless as possible, fixating the gaze on a stationary object until the symptoms of vertigo diminish. After the attack passes, individuals may need to sleep for several hours.

Individuals may be instructed to use a noninvasive pressure pulse generator to decrease excess endolymphatic fluid in the ear and help reduce symptoms. The pulse generator device is typically used for 5 minutes, 3 times a day at home (Hain). For individuals with persistent and severe vertigo, several surgical procedures are available. Removal of the inner ear sense organ (labyrinthectomy) may control vertigo but is only recommended for individuals with nonfunctional hearing in the affected ear as it may cause more hearing loss. Another procedure, vestibular neurectomy, severs a nerve from the affected inner ear organ and usually controls the vertigo while maintaining hearing, but carries significant surgical risks. An operation to place an endolymphatic shunt has also been tried, but the shunt can plug up easily. In recent years, injecting the ototoxic antibiotic gentamicin through the eardrum directly into the middle ear space, where it perfuses into the inner ear, has been successful for controlling vertigo caused by Ménière’s disease.

Source: Medical Disability Advisor



Prognosis

Ménière’s disease is generally progressive, although the pace of the disease varies. Some individuals experience spontaneous remission of varying duration for unknown reasons. If the condition affects one ear, the disease may progress, over time, to both ears. Some individuals may become totally or functionally disabled by vertigo, deafness, and/or tinnitus. Most individuals will progressively lose their hearing, becoming totally or functionally deaf, and some may require hearing aids (Hain).

Approximately 70% of individuals using the noninvasive pressure pulse generator device will experience improvement in symptoms (Hain). Up to 90% of individuals with gentamicin injections into the middle ear report effective control of vertigo symptoms (Bodmer, Chung); however, although a single injection causes reduced hearing in 5% of individuals, multiple injections result in significant hearing loss in 71% of individuals (Chung). For individuals in whom hearing loss has already occurred, labyrinthectomy is 95% successful (Li). In many cases, symptoms can be treated successfully, and the condition can be managed.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Neurologist
  • Otolaryngologist

Source: Medical Disability Advisor



Rehabilitation

Although rehabilitation is not generally indicated in this disorder, individuals with frequent bouts of vertigo may benefit from a few physical or occupational therapy sessions to discuss safety issues pertaining to balance, strategies for optimal positioning, and how to remain stationary for greater relief. In some cases, vestibular rehabilitation is helpful to control symptoms by causing brain adaptation.

Source: Medical Disability Advisor



Comorbid Conditions

  • Diseases affecting the inner ear, brain stem, or associated nerve pathways
  • Immune system disorders

Source: Medical Disability Advisor



Complications

Untreated or unresolved Ménière’s disease may result in permanent hearing loss and chronic ringing in the ear (tinnitus). If surgery is needed, individuals may experience hearing loss as a complication of the procedure. Even when more severe symptoms are resolved, the individual may experience an ongoing feeling of unsteadiness and dizziness for an indefinite time, increasing the risk of falls. Some individuals with Ménière’s disease experience severe, often debilitating headaches (migraine). Once Ménière’s disease occurs in one ear, the chance of the other ear being affected is significant.

Source: Medical Disability Advisor



Factors Influencing Duration

The severity of symptoms and frequency of attacks may influence recovery time. The individual’s response to treatment will also determine the length of disability. If surgical intervention is required, additional recovery time may be required. In some cases, the individual’s symptoms may continue indefinitely. Some individuals experience permanent hearing loss.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The severity of vertigo and the extent of hearing loss should be considered in possible work situations. In unresolved cases of Ménière’s disease, tasks requiring keen hearing or good physical balance may need to be reassigned. As an example, individuals who climb ladders or operate heavy equipment may be unable to continue fulfilling these duties. Some individuals may be unable to continue tasks that involve driving. Workers who must continually change positions (e.g., aerobics instructors, painters) may be severely affected. Individuals with hearing impairment may require accommodations such as telephone adaptations, interpreters, visual aids, video captions, hearing aids, or amplification at workstations. In some cases, disability may be permanent.

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 hearing loss, pressure in the ear, tinnitus, and vertigo? Are one or both ears affected?
  • Has individual had a hearing test? EMG? Brain stem–evoked response? MRI?
  • Has individual had any blood tests?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual on diuretic therapy? Have sedatives been prescribed?
  • Is individual following a low-salt diet and avoiding caffeine and nicotine?
  • Has individual tried a noninvasive pressure pulse generator? Gentamicin injections?
  • Has surgery been necessary?

Regarding prognosis:

  • Has individual received training in safety issues?
  • Is individual’s employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications such as hearing loss as a complication of the surgical procedure, an ongoing feeling of unsteadiness for an indefinite time, or severe migraine headaches?

Source: Medical Disability Advisor



References

Cited

"Meniere's Disease." National Institute on Deafness and Other Communication Disorders. 20 Jul. 2009. National Institutes of Health (NIH). 1 Apr. 2008 <http://www.nidcd.nih.gov/health/balance/meniere.asp>.

Bodmer, D., et al. "Long-Term Vertigo Control in Patients after Intratympanic Gentamicin Instillation for Meniere’s Disease." Otology and Neurotology 28 8 (2007): 1140-1144.

Chung, W. H., et al. "Effects of a Single Intratympanic Gentamicin Injection on Meniere’s Disease." Acta Otolaryngol Suppl 558 (2007): 61-66.

Hain, T. C. "Meniere’s Disease." American Hearing Research Foundation. Oct. 2008. 20 Jul. 2009 <http://www.american-hearing.org/disorders/menieres/menieres.html>.

Ibekwe, T. S., et al. "Migraine and Meniere’s Disease: Two Different Phenomena wih Frequently Observed Concomitant Occurrences." Journal of the National Medical Association 100 3 (2008): 334-338.

Li, John C. "Inner Ear, Meniere Disease, Surgical Treatment." eMedicine. Eds. Michael E. Hoffer, et al. 3 Sep. 2008. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/856658-overview>.

Wilkerson, R. Gentry, and Christopher I. Doty. "Meniere Disease." eMedicine. Eds. Mark S. Slabinski, et al. 2 Jul. 2009. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/792902-overview>.

Source: Medical Disability Advisor