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.

Operations on Uvula


Related Terms

  • Laser Assisted Uvulapalatoplasty (LAUP)
  • Uvulectomy
  • Uvulopalatopharyngoplasty (UPPP)

Specialists

  • Otolaryngologist

Comorbid Conditions

  • Bleeding disorders
  • Chronic obstructive pulmonary disease (COPD)/impaired pulmonary function
  • Obesity

Factors Influencing Duration

Length of disability for individuals having UPPP depends on the extent of surgery, whether they need several small, repeated procedures, their pulmonary (lung) health, the extent of their pain, and any complications from the surgery. Individuals having LAUP are affected by the same factors, but tend to recover much more quickly.

Medical Codes

ICD-9-CM:
27.7 - Operations on Uvula
27.71 - Incision of Uvula
27.72 - Excision of Uvula
27.73 - Repair of Uvula
27.79 - Other Operations on Uvula

Overview

The uvula is a piece of soft tissue that hangs down off the soft palate at the back of the throat. Normally, dilator muscles hold this tissue in place and keep the airway open. However, poor muscle tone can cause the uvula to sag into the airway and narrow or obstruct it while the individual is asleep. A partially blocked airway often causes vibrations of the uvula that result in snoring. A fully blocked airway results in a group of disorders called obstructive sleep apnea (OSA), where breathing stops intermittently while the individual is asleep. Individuals with sleep apnea stop breathing for 10 seconds or longer five or more times each hour during sleep. This decreases the amount of oxygen in the blood and over time can cause problems such as hypertension, morning headaches, excessive daytime sleepiness, and impaired mental and emotional functioning.

In addition to airway blockage caused by poor muscle tone, structural abnormalities, such as a long narrow uvula and long soft palate, increase the likelihood of airway blockage and OSA. The uvula is not always the only tissue causing airway blockage. The base of the tongue may be thickened to the point where it interferes with nighttime breathing. Only rarely are cysts or tumors the cause of airway blockage.

Surgery on the uvula is normally done only after other therapeutic methods of controlling OSA have been exhausted. The most common nonsurgical treatment for OSA is the use of nasal continuous positive airway pressure (CPAP). The individual wears a mask at night that is hooked to a machine that supplies air under pressure to keep the airway open. Dental appliances are also used to keep the airway open. However, when these mechanical devices fail to control sleep apnea, surgery is often recommended.

The type of surgery depends on the cause of the airway blockage. Common operations on the uvula include uvulopalatopharyngoplasty (UPPP) and laser assisted uvulapalatoplasty (LAUP). Other surgeries for sleep apnea that remove obstructions caused by tissues other than the uvula include tongue advancement, surgery on the hyoid bone under the chin (hyoid surgery), and surgery to move the upper or lower jaw forward (maxillary or maxillomandibular advancement). Snoreplasty is a new nonsurgical procedure that uses injections of chemicals that cause scarring relatively to stiffen the soft palate in an effort to reduce the vibrations of the uvula that cause snoring.

Source: Medical Disability Advisor



Reason for Procedure

Operations on the uvula are performed to reduce the amount of tissue in the airway as a means of eliminating snoring and preventing obstructive sleep apnea. The surgery may also block some of the muscle action that causes the airway to collapse and improve the movement of the soft palate. The surgery cannot be performed in individuals with a submucous cleft palate.

Source: Medical Disability Advisor



How Procedure is Performed

There are two main operations on the uvula: uvulopalatopharyngoplasty (UPPP), and laser assisted uvulapalatoplasty (LAUP), also sometimes called uvulectomy.

UPPP is the most common surgical procedure to treat OSA. Conventional UPPP (using a scalpel) is normally done in a hospital under general anesthesia and requires an overnight stay. It has been performed in the US since 1981. UPPP involves more than just the uvula. The tonsils are also removed (tonsillectomy). A portion of the uvula and the rim of the soft palate are removed, and any excess tissue in the pharynx is excised. Sometimes UPPP is performed in a series of 3 to 5 operations spaced anywhere from 3 to 8 weeks apart with small amounts of tissue being removed during each procedure.

Other surgery may be performed along with UPPP to re-align the airway and remove obstructions. The exact type of surgery depends in the cause of the airway obstruction. For example, part of the hard palate may be removed (transpalatal advancement pharyngoplasty). The base of the tongue may be reduced in size or reshaped (lingualplasty). The muscles of the tongue may be pulled forward to prevent the throat from collapsing (genioglossus and hyoid advancement). In extreme cases, the upper or lower jaw may also be re-aligned (maxillary-mandibular advancement). Normally UPPP is attempted first before these more complex surgeries are performed.

LAUP was first developed in 1993. This surgery uses a carbon dioxide laser to remove the uvula and sometimes part of the soft palate. It is performed mainly on individuals who have few symptoms of OSA, but who have chronic snoring. This procedure can be performed in a doctor's office or outpatient surgery center, with the individual returning home the same day.

In LAUP, the back of the throat is numbed with a topical spray. A laser is used to vaporize excess tissue, so that the uvula is shortened. As with conventional UPPP, the tissue may be removed in a series of small procedures with an interval of several weeks of recovery between surgeries.

Source: Medical Disability Advisor



Prognosis

The success rate for UPPP ranges from 40% to 60% (Downey; Herpel 1017; Strohl 465). The success rate is highest for individuals who have abnormalities in the construction of the soft palate. Individuals who are obese often show initial improvement, followed by recurrence of symptoms of OSA. Individuals who are no more than 25% over their ideal body weight are the most likely to experience long-term benefits from the surgery (Morgan). The success rate also varies substantially among individual physicians and facilities.

LAUP is initially successful in reducing snoring in about 90% of individuals (Downey). However, the procedure may cause scarring and lead to increased symptoms of OSA. The long-term success rate of this procedure is still unclear as a cure for snoring. Treatment of OSA using LAUP is still under investigation.

Source: Medical Disability Advisor



Complications

Complications of UPPP include swelling (edema) after the operation that can close the airway. In the event of severe swelling, a temporary tracheostomy must be performed. Other complications of the procedure include severe sore throat, problems swallowing, changes in the voice, excess mucus in the throat, regurgitation of stomach contents, and impaired sense of smell or taste. Excess bleeding (hemorrhage) occurs in 2-4% of individuals (Downey). Failure to improve symptoms of sleep apnea or recurrence of symptoms is common.

Complications of LAUP include sore throat, dry throat, and occasionally increased snoring. Silent sleep apnea—that is apnea that is not telegraphed by snoring—may occur in individuals whose snoring has been eliminated through LAUP.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

UPPP is a painful treatment. Both UPPP and LAUP cause severe sore throat. Individuals may need pain medication that may interfere with their ability to drive or operate machinery upon their return to work. Individuals whose work involves a great deal of speaking may need to be reassigned temporarily to jobs where they do not need to use their voice as much.

Source: Medical Disability Advisor



References

Cited

Downey, Ralph, and Himanshu Wickramasinghe. "Apnea, Sleep." eMedicine. Eds. Sat Sharma, et al. 4 Jun. 2004. Medscape. 27 Dec. 2004 <http//emedicine.com/med/topic163.htm>.

Herpel, Laura B., and Carolyn Wong Simkins. "Sleep-Disordered Breathing." The Osler Medical Handbook. Eds. Alan Cheng and Aimee Zaas. 1st ed. Baltimore: Johns Hopkins University Press, 2003. 1011-1019.

Morgan, Charles E., and Jonathan P. Lindman. "Snoring and Obstructive Sleep Apnea, Surgery." eMedicine. Eds. Hassan H. Ramadan, et al. 2 Aug. 2004. Medscape. 27 Dec. 2004 <http//emedicine.com/ent/topic370.htm>.

Rowley, James, and Nicholas Lorenzo. "Obstructive Sleep Apnea." eMedicine. Eds. Carmel Armon, et al. Medscape. 4 May 2005 <emedicine.com/neuro/topic419.htm>.

Strohl, Kingman P. "Obstructive Sleep Apnea-Hypopnea Syndrome." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 462-466.

Weissler, Mark C., and Scott Scharer. "What's New in Otolaryngology - Head and Neck Surgery." Journal of the American College of Surgeons 199 1 (2004): 114-123.

Source: Medical Disability Advisor






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