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 Media


Related Terms

  • Acute Middle Ear Disease
  • Allergic Otitis Media
  • Chronic Middle Ear Disease
  • Ear Infection
  • Middle Ear Infection
  • Nonsuppurative Otitis Media
  • Otitis Media with Effusion
  • Purulent Otitis Media
  • Secretory Otitis Media
  • Serous Otitis Media
  • Suppurative Otitis Media

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Otolaryngologist
  • Radiologist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the duration of disability include the individual's health status, including pre-existing diseases affecting major body systems (e.g., diabetes, HIV infection/AIDS, cancer); suppressed immune system function; the type and virulence of infection; infection with an antibiotic-resistant organism; the individual's compliance with the treatment regimen; response to treatment; complications requiring surgery; and whether the individual is exposed to passive smoking at work or at home.

Medical Codes

ICD-9-CM:
381 - Otitis Media and Eustachian Tube Disorders, Nonsuppurative
381.0 - Acute Nonsuppurative Otitis Media; Acute Tubotympanic Catarrh; Catarrhal; Exudative; Transudative; with Effusion
381.00 - Otitis Media, Acute Nonsuppurative, Unspecified
381.01 - Otitis Media, Acute Serous
381.02 - Acute Mucoid Otitis Media; Acute or Subacute Seromucinous Otitis Media; Blue Drum Syndrome
381.03 - Acute Sanguinous Otitis Media
381.04 - Acute Allergic Serous Otitis Media
381.05 - Acute Allergic Mucoid Otitis Media
381.06 - Acute Allergic Sanguinous Otitis Media
381.1 - Otitis Media, Chronic Serous; Chronic Tubotympanic Catarrh
381.10 - Chronic Serous Otitis Media, Simple or Unspecified
381.19 - Otitis Media, Chronic Serous; Chronic Tubotympanic Catarrh, Other; Serosanguinous Chronic Otitis Media
381.2 - Otitis Media, Chronic Mucoid
381.20 - Chronic Mucoid Otitis Media, Simple or Unspecified
381.29 - Otitis Media, Chronic Mucoid, Other; Mucosanguinous Chronic Otitis Media
381.3 - Chronic Nonsuppurative Otitis Media, Other and Unspecified; Otitis Media, Allergic; Exudative; Secretory; Seromucinous; Transudative; with Effusion
381.4 - Nonsuppurative Otitis Media, Not Specified as Acute or Chronic; Allergic; Catarrhal; Exudative; Mucoid; Secretory; Seromucinous; Serous; Transudative; with Effusion
382 - Otitis Media, Suppurative and Unspecified
382.0 - Otitis Media, Acute Suppurative
382.00 - Otitis Media, Acute Suppurative without Spontaneous Rupture of Ear Drum
382.01 - Acute suppurative otitis media with Spontaneous Rupture of ear Drum
382.9 - Otitis Media, Unspecified

Overview

Otitis media is an infectious inflammation of the lining of the middle ear, eardrum (tympanic membrane), and associated structures such as the small bones of the ear (ossicles) and the tube that connects the ear to the throat (Eustachian tube). Because fluid buildup behind the tympanic membrane can cause poor transmission of sound waves, otitis media may be associated with some degree of conductive hearing loss.

Acute otitis media usually follows a viral upper respiratory infection or trauma to the ear, but it is sometimes associated with an allergy or enlarged adenoids (Cook). Different forms of acute otitis media (serous, or secretory; suppurative, or purulent) are based on the severity of the infection and the involvement of different parts of the ear. With serous otitis media, Eustachian fluid builds up behind the tympanic membrane following a previous ear infection, resulting in conductive hearing loss. Suppurative otitis media involves the build-up of fluid in the middle ear in conjunction with a perforated tympanic membrane. When bacteria introduced into the middle ear from the nasopharynx, caused a pus-producing infection, the most common causative organisms (pathogens) are Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes.

Otitis media of less than 3 weeks duration (acute) is one of the most common infections of childhood, especially between the ages of 6 months to 36 months, although it is also seen in adults (Cook). Recurrent acute otitis media becomes chronic when it persists for longer than 3 months and is accompanied by changes in the lining of the middle ear. Growth of new tissue (granulation tissue) may extend into the middle ear. Often the result of untreated ear infections, chronic otitis media is considered more dangerous because the slow, prolonged effects can result in permanent damage. Chronic otitis media may not be noticed or cause enough discomfort to warrant immediate action until it is well established.

Incidence and Prevalence: Incidence of chronic suppurative otitis media is 39 cases per 100,000 children (Parry).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Young age is a risk factor for otitis media, with over 70% of children experiencing an infection by the age of 3 and with any late complications occurring by age 20 (Eaton). Adults at increased risk for otitis media are those with a family history for middle ear disease, those who experienced acute otitis media within the first year of life, who have recurrent upper respiratory infections, and those exposed to passive smoking (Cook). Individuals with upper respiratory infections who scuba dive or fly in an airplane also may develop otitis media caused by persistent negative middle ear pressure. Chronic otitis media is more common in adults who have had recurrent childhood acute otitis. Acute otitis media is most common during the fall and winter months (Cook).

Otitis media is most prevalent among individuals of Native American and Inuit descent, due to the increased width of their Eustachian tubes that form a conduit for bacteria; 8% of Native Americans and 12% of Inuits are affected (Parry). Otitis media is more prevalent in whites than in African-Americans (Donaldson).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with acute otitis media may complain of moderate to severe ear pain (otalgia), pain behind the ear, fever, decreased hearing, fluid drainage from the ear, dizziness, or a sense of fullness in the ear (aural pressure). Individual may report a recent or concurrent upper respiratory infection.

Individuals with chronic otitis media often report a history of recurrent acute otitis media, long-term decreased hearing, and a chronically draining ear. Pain usually does not accompany chronic otitis media unless the individual has an upper respiratory infection.

Physical exam: Physical findings vary depending on the type of infection present. When examined through an otoscope, the tympanic membrane associated with acute otitis media is red (erythema), with slow or absent mobility. Painful blisters (bullae) occasionally form on the tympanic membrane, or the membrane will bulge outward because of the severe infection behind it. Without medical intervention, bulging tympanic membranes may eventually rupture, and fluid will drain from the ear canal. This event brings an immediate decrease in the level of pain. When examined through an otoscope, the tympanic membrane associated with chronic otitis media may be perforated or scarred, and drainage from the middle ear will be present in the ear canal. If the infection is very severe, neurological symptoms also may be present (e.g., signs of increased intracranial pressure, facial paralysis, meningitis).

Tests: Fluid drawn from behind the tympanic membrane with a needle and syringe (tympanocentesis) may be sent to the laboratory for culture and sensitivity testing to identify the causative organism and determine the appropriate antibiotic to use in treating the infection. Audiometric studies may be performed to test the degree of conductive hearing loss. Tympanometry can be used to test the function of the middle ear, and the mobility of the tympanic membrane. Magnetic resonance imaging (MRI) or computed tomography (CT) may be ordered if chronic otitis media or infection of the bone behind the ear (mastoiditis) is suspected. There may be temporal bone destruction, the absence of ossicles, or the presence of a mass of dead cells in the middle ear (cholesteatoma). If neurological symptoms are present, MRI or CT may reveal inflammation of the lining of the brain and spinal cord (meninges).

Source: Medical Disability Advisor



Treatment

Analgesics such as acetaminophen are used in all individuals. Adults can receive intranasal vasoconstrictors (e.g., phenylephrine) or systemic decongestants (e.g., pseudoephedrine) to improve Eustachian tube function; due to the risk of rebound symptoms, these drugs are used during no more than 4 days. Antihistamines should be reserved for individuals with allergies. Treatment of bacterial acute otitis media focuses on clearing the middle ear of infection. However, antibiotic therapy is thought not to be useful in cases of mild otitis media and should be reserved for severe cases in which symptoms do not begin to resolve within 48 to 72 hours (Cook). In these cases, acute otitis media may be treated with a broad-spectrum antibiotic pending the results of culture and sensitivity testing. Based on the results of sensitivity testing, more specific antibiotic therapy may be ordered. Standard medical therapy for severe acute otitis media includes prescribing antibiotics for 10 days (Cook). If serious complications occur, the individual may need 2 to 4 weeks of treatment with intravenous antibiotics (Eaton).

In acute middle ear infections, insertion of ventilating tubes into the tympanic membrane through a surgical drainage incision (myringotomy) is reserved for individuals with severe ear pain or complications such as mastoiditis or meningitis, involvement of the facial nerve, or signs of brain abscess.

Recurrent acute otitis media may be managed with long-term preventative antibiotic therapy for 1 to 3 months. If this regimen fails to control the infection and pain is severe, a myringotomy may be required. Tympanic membranes rupturing spontaneously usually heal by themselves. Persistent perforation frequently evolves into chronic otitis media.

Serous otitis media can occur after acute otitis media and can be refractory to treatment with antibiotics. It may spontaneously resolve over several months (Ruben). If symptoms persist past 3 months, placement of a ventilating tube (tympanostomy tube) through a myringotomy incision in the tympanic membrane to promote drainage may restore hearing and alleviate aural pressure (Ruben). In adults, this usually is an office procedure.

Treatment of chronic otitis media requires the regular removal of infected debris from the middle ear through the perforation (an outpatient procedure), use of earplugs to protect against water exposure, and topical antibiotic drops to help dry chronic ear drainage and reduce ear infection. Surgery (myringoplasty or tympanoplasty) usually is required to repair the perforation or remove a cholesteatoma that eventually grows in the middle ear, mastoid process, or mastoid region, erodes bone and invades the middle ear.

Source: Medical Disability Advisor



Prognosis

The majority of cases of acute otitis media are self-limiting; 80% of individuals will improve within 24 to 48 hours on their own and may be symptom-free after several days (Cook). However, when antibiotic therapy is needed, full recovery depends on the individual's compliance with a complete course of therapy, regardless of how well the individual feels after a few doses. Disruption in antibiotic therapy before the individual has taken the entire prescription can result in a recurrence of the infection and may contribute to the growth of antibiotic-resistant organisms.

Outcomes for chronic otitis media are less predictable, and outpatient treatment tends to be ongoing. At some point, surgery often is required to reconstruct the perforated eardrum (tympanoplasty), clear the mastoid air cells of infection (mastoidectomy), and remove the growth of excess tissue in the ear canal (removal of cholesteatoma).

Conductive hearing loss from acute otitis media typically resolves with time. Permanent hearing loss can result from chronic otitis media.

Source: Medical Disability Advisor



Rehabilitation

Because the middle and inner ear not only allow an individual to hear but also contribute to balance, rehabilitation is important if any problems with balance and equilibrium occur. Once the initial infection resolves, individuals may need a physical therapist trained in vestibular rehabilitation to help regain any loss of balance. A physician evaluates the individual to determine if the balance problem is a result of an inner ear dysfunction or arises from dysfunction in other areas such as the brain's center for balance. Once this is determined, the physician and the physical therapist establish a rehabilitation plan. Much of the therapy focuses on balance exercises that challenge the individual's balance with and without the help of visual and somatosensory stimuli. The physical therapist may need to modify the program for individuals who have undergone surgery, those with hearing loss due to birth defects, or those who have a long-standing infection.

Individuals with permanent conductive hearing loss may require vocational or occupational therapy to help prepare them for a different job. Amplification (use of hearing aids) may be required, depending on the severity of the hearing loss.

Source: Medical Disability Advisor



Complications

If treatment of acute or chronic otitis media fails, infection can spread to other areas of the head and neck, causing serious, even life-threatening complications. Acute suppurative mastoiditis requires surgical drainage. Infection of the petrous bone (petrous apicitis), situated between the inner and middle ear, requires prolonged antibiotic therapy and surgical drainage. Infection of the bones (osteomyelitis) forming the base of the skull requires antibiotic therapy and possible surgical débridement of the infected bone. Facial paralysis caused by inflammation of the facial nerve requires drainage of the middle ear and intravenous antibiotic therapy. Facial palsy caused by chronic pressure on the facial nerve requires oral corticosteroid and antibiotic therapy, a myringotomy, and occasionally more aggressive surgical correction of the underlying disease (e.g., removal of cholesteatoma, mastoidectomy). Other complications of otitis media include tympanic membrane perforation, balance disorders (acute labyrinthitis), septic arthritis, and infection of the tissue lining the heart and the heart valves (bacterial endocarditis).

Complications involving the nervous system can be particularly dangerous. Thrombosis of the sigmoid sinus can lead to overwhelming infection (sepsis) and increased intracranial pressure. Treatment for this condition includes administration of intravenous antibiotics based on culture and sensitivity testing, surgical drainage, or tying off the vein in the neck. Central nervous system infections include epidural abscess, brain abscess, and meningitis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations for individuals with acute or chronic otitis media are related to the degree of hearing loss. Because hearing loss caused by acute otitis media usually is temporary, accommodations also are temporary. Hearing most often will return to normal levels when the infection clears, normal pressure is re-established in the Eustachian tube, and the fluid behind the eardrum is absorbed. This may take a few weeks. Hearing loss associated with chronic otitis media lasts longer and may become permanent, requiring a long-term or permanent accommodations in the workplace in addition to the use of hearing aids. Balance disorders resulting from ear infections may require work restrictions for the safety of the individual and co-workers.

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:

  • Did individual recently have an upper respiratory tract infection?
  • Does individual have a history of allergies or enlarged adenoids? History of recurrent acute otitis media, family history of middle ear disease, long-term decreased hearing, and/or a chronically draining ear?
  • Has individual recently experienced trauma to the ear?
  • Is individual exposed to passive smoking?
  • Does individual have a suppressed immune system?
  • Does individual participate in activities that cause negative middle ear pressure, such as scuba diving or flying?
  • Does individual complain of moderate to severe otalgia, pain behind the ear, fever, decreased hearing, fluid drainage from the ear, dizziness, or increased aural pressure?
  • Was tympanocentesis done and fluid cultured? If so, what was the causative organism of the infection?
  • Was tympanic membrane perforated? Scarred?
  • Were audiometric studies performed to determine the degree of conductive hearing loss?
  • Did tympanometry test the function of the middle ear and the mobility of the tympanic membrane?
  • Was MRI or CT done if chronic otitis media was suspected?
  • Was the diagnosis of acute or chronic otitis media confirmed?

Regarding treatment:

  • Did individual's symptoms persist beyond 48 to 72 hours, making antibiotic therapy necessary?
  • Was acute otitis media treated initially with a broad-spectrum antibiotic? Did the antibiotic need to be changed when the organism was identified?
  • Was individual compliant with the antibiotic regimen?
  • Was recurrent acute otitis media managed with long-term preventative antibiotic therapy?
  • If that regimen failed, did individual require myringotomy?
  • Was persistent serous otitis media treated with oral corticosteroids and antibiotics?
  • Was placement of a tympanostomy tube required to restore hearing and alleviate aural pressure?
  • Was chronic otitis media treated with removal of material from the middle ear and antibiotic drops?
  • Was myringoplasty or tympanoplasty required to repair perforation or remove a cholesteatoma in the middle ear?

Regarding prognosis:

  • Is this an acute or recurrent infection?
  • Was the reason for recurrent infection established?
  • Has an antibiotic sensitivity test indicated a better option or more effective combination of drugs?
  • Is there lack of compliance with antibiotic regimen? If so, what is being done to ensure compliance?
  • Are underlying medical conditions affecting the individual's ability to recover?
  • Have complications developed, such as thrombosis of the sigmoid sinus, sepsis, or increased intracranial pressure?
  • Has a central nervous system infection developed, such as epidural abscess, brain abscess, or meningitis?
  • What treatment is available for complications and what is the expected outcome with treatment?
  • Does individual have temporary or permanent hearing loss?
  • Can employer make appropriate accommodations for hearing loss?

Source: Medical Disability Advisor



References

Cited

Cook, Kathy A., and Matthew J. Walsh. "Otitis Media." eMedicine. Eds. Jerry Balentine, et al. 16 Jul. 2008. Medscape. 6 Oct. 2009 <http://emedicine.medscape.com/article/764006-overview>.

Donaldson, John D. "Middle Ear, Acute Otitis Media, Medical Treatment." eMedicine. Eds. Carol A. Bauer, et al. 28 Sep. 2009. Medscape. 6 Oct. 2009 <http://emedicine.medscape.com/article/859316-overview>.

Eaton, Debbie A., and Alan D. Murray. "Complications of Otitis Media." eMedicine. Eds. Robert A. Battista, et al. 3 Sep. 2009. Medscape. 6 Oct. 2009 <http://emedicine.medscape.com/article/860323-overview>.

Parry, David, and Peter S. Roland. "Middle Ear, Chronic Suppurative Otitis, Medical Treatment." eMedicine. Eds. John C. Li, et al. 7 Jul. 2009. Medscape. 6 Oct. 2009 <http://emedicine.medscape.com/article/859501-overview>.

Rubin, Robert J. "Secretory Otitis Media." The Merck Manual of Diagnosis and Therapy. Eds. Robert S. Porter, et al. 18th ed. Whitehouse Station, NJ: Merck and Company, Inc., 2008.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.