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.

Otitis Externa, Infective


Related Terms

  • Otorrhea
  • Swimmer's Ear

Differential Diagnosis

Specialists

  • Dermatologist
  • Infectious Disease Internist
  • Neurologist
  • Otolaryngologist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the individual's general health, pre-existing diseases affecting major body systems (e.g., diabetes, HIV/AIDS, leukemia, or cancer), whether the individual has a functional immune system, the type and virulence of infection, the presence of antibiotic-resistant organisms, the individual's compliance with treatment regimen and response to treatment, any complications requiring surgery, and whether the individual works or lives in a humid environment.

Medical Codes

ICD-9-CM:
380.12 - Acute Swimmers Ear; Beach Ear; Tank Ear

Overview

Infective otitis externa, also known as "swimmer's ear," is an inflammation of the skin of the external ear canal and the folds of skin and cartilage that make up the visible part of the ear (auricle or pinna). The infection is usually caused by bacteria (most often Pseudomonas aeruginosa or Staphylococcus aureus), but it can also be caused by a fungus (usually Aspergillus or Candida albicans). Conditions that promote otitis externa include loss of earwax (cerumen), usually due to frequent exposure to water, trapping water in the ear canal through the use of earplugs, and damaging the skin when cleaning the ear with a cotton swab or other object.

Chronic otitis externa is occasionally caused by dermatitis such as seborrhea, eczema, or psoriasis. Although infective otitis externa is not a serious disease for most people, immunocompromised individuals (e.g., those with AIDS or diabetes) can develop a life-threatening form of the disease called necrotizing otitis externa. In that condition, the bacteria enter the bones around the ear and cause infection and bone erosion.

Incidence and Prevalence: Otitis externa is common worldwide, especially among individuals who participate in water sports. It is estimated that 1 of every 250 Americans gets otitis externa each year. Necrotizing otitis externa is rare but life-threatening.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Although individuals of any age can develop otitis externa, it is most common in young adults. It occurs frequently in individuals who swim regularly. People who have allergies or who live in warm, humid environments are also at higher risk for developing otitis externa. The risk is independent of sex or race.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with infective otitis externa complain of moderate to severe external ear pain that is sometimes disproportionate to the infection's apparent severity. Pressing directly in front of the ear is especially painful. Clenching the teeth, opening the mouth, or chewing may also increase pain. The individual often reports recent exposure to water or mechanical trauma to the ear canal (e.g., scratching with a sharp object or cotton applicator). Fever may or may not be present. Swelling of the ear canal can block hearing and may cause dizziness or ringing of the ears. In chronic otitis externa or disease caused by fungal infections, itching, rather than pain, is the chief symptom.

Physical exam: An examination of the external ear canal with an otoscope reveals redness (erythema) and swelling (edema). A purulent, foul-smelling discharge (otorrhea) is often present. Movement (manipulation) of the ear usually causes pain. Pain on movement of the external ear structures distinguishes otitis externa from middle ear infection (otitis media). If the canal is very swollen, it may be impossible to visualize the eardrum with an otoscope. When visualized, however, the eardrum is found to move normally. Usually, the lymph nodes in front of or behind the external ear (periauricular lymphadenopathy) are tender. Symptoms normally occur only in one ear at a time.

Tests: Normally, otitis externa is diagnosed by physical examination. However, a sample of the discharge may be submitted to the laboratory for culture and sensitivity testing. A culture identifies the organism (pathogen) causing the infection. Sensitivity indicates the most appropriate antibiotic for treatment. If necrotizing otitis externa is suspected, a CT scan may be done to visualize the extent of bone erosion.

Source: Medical Disability Advisor



Treatment

Treatment of individuals with intact immune systems consists of over-the-counter pain medication and warm moist compresses applied to the ear area. Debris is gently removed from the ear canal. Eardrops containing both an antibiotic to treat the infection and a corticosteroid to reduce inflammation may be prescribed. If swelling prevents penetration of the drops, a cotton ear-wick is inserted into the swollen ear canal to absorb the drops and deliver medication to the area most in need of treatment. If fever persists or regional inflammation (cellulitis) develops, oral antibiotics may be prescribed. If the culture identifies fungus as the cause of infection, antifungal drops are prescribed instead of antibiotics. While the condition is healing, the ear must be protected from moisture and further scratching of the ear canal.

Treatment in immunocompromised individuals is much more aggressive. These individuals are usually started immediately on oral antibiotics. In some cases, hospitalization and intravenous (IV) antibiotics may be administered. Antibiotic treatment may continue for 6 weeks. If pus or dead tissue is present in the ear canal, the ear is cleaned. If an abscess is present in the ear canal, it is lanced and drained by an otolaryngologist.

Source: Medical Disability Advisor



Prognosis

With proper treatment, the individual with acute otitis externa should notice improvement within 48 hours. Despite improvement, the ear needs to remain dry for 1 to 2 weeks to complete healing. Chronic otitis externa does not have a predictable outcome and may recur. Necrotizing otitis is rare but historically has a 50% mortality rate (Waitzman).

Source: Medical Disability Advisor



Rehabilitation

Individuals with decreased balance as a result of infective otitis externa may require a consultation session with a physical therapist. The physical therapist can provide gait instruction with the use of a cane or walker and may suggest other safety measures, such as grab bars in the shower.

Source: Medical Disability Advisor



Complications

The condition may become recurrent, especially if a fungus caused it and the individual remains in a humid environment. Persistent otitis externa in diabetic or immunocompromised individuals may evolve into necrotizing otitis externa. This condition is characterized by a foul-smelling discharge from the ear, deep ear pain (otalgia), progressive paralysis of certain cranial nerves, infection, and bone erosion.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Because of severe ear pain and the need to keep the ear canal as dry as possible, an individual with infective otitis externa should not wear earplugs or clothing or protective gear that covers the ear. Because hearing is reduced in the affected ear, temporary reassignment to a position not requiring frequent phone calls may be necessary. Exposure of the ear canal to water or extremely humid conditions should be avoided during the healing process. Exposure to chemical environments that emit fumes and vapors also may delay the healing process. Individuals with chronic otitis externa may need to indefinitely avoid warm, moist environments and water exposure.

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 complain of moderate to severe external ear pain that is sometimes disproportionate to the infection's severity? If front of ear is pressed, is it painful? Does clenching the teeth, opening the mouth, or chewing increase pain?
  • Was individual recently exposed to water or mechanical trauma to the ear canal (scratching with a sharp object or cotton applicator)?
  • Does swelling of the ear canal block hearing? If so, does it cause dizziness?
  • Is itching present rather than pain?
  • On exam, was ear canal red (erythema) and swollen (edema)? Was a purulent, foul-smelling discharge (otorrhea) present?
  • Was diagnosis of infective otitis externa confirmed? Was source of infection identified?

Regarding treatment:

  • Was a culture and sensitivity done to identify the organism and determine the most effective antibiotics and/or antifungal drops?
  • Were eardrops prescribed containing both an antibiotic to treat the infection and a corticosteroid to reduce inflammation? Did swelling prevent entry of drops? If so, was medication administered with a cotton ear-wick?
  • Are eardrops used at room temperature to decrease dizziness during application?
  • Did fever persist or regional inflammation (cellulitis) develop? If so, were oral antibiotics given?
  • Did individual protect ear from moisture and further scratching of the ear canal?
  • Was CT scan done to look for bone involvement?

Regarding prognosis:

  • Has individual experienced complications that may affect recovery?
  • Does individual have an underlying condition that may affect recovery?
  • Is the climate or workplace environment dry enough to be conducive to healing?
  • Is individual applying the eardrops correctly? Is individual using good, clean technique when applying the eardrops so that the organisms causing the infection are not introduced back into the bottle of drops?
  • Is individual keeping ear dry to permit healing?

Source: Medical Disability Advisor



References

Cited

Waitzman, Ariel A. "Otitis Externa." eMedicine. Ed. Orval Brown. 28 Oct. 2004. Medscape. 2 Nov. 2004 <http://emedicine.com/ped/topic1688.htm>.

Source: Medical Disability Advisor






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