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.

Sinusitis


Related Terms

  • Acute Sinusitis
  • Chronic Bacterial Sinusitis
  • Ethmoidal Sinusitis
  • Frontal Sinusitis
  • Invasive Fungal Sinusitis
  • Maxillary Sinusitis
  • Rhinosinusitis
  • Sinus Infection
  • Viral Sinus Infection

Differential Diagnosis

  • Allergic rhinitis
  • Bronchitis
  • Mucormycosis
  • Rhinoviruses
  • Sinus tumor
  • Upper respiratory infection
  • Wegener’s granulomatosis

Specialists

  • Allergist/Immunologist
  • Family Physician
  • Internal Medicine Physician
  • Otolaryngologist

Comorbid Conditions

  • Asthma
  • Chronic respiratory diseases (e.g., COPD, emphysema)
  • Cystic fibrosis
  • Diabetes
  • Immunodeficiency (AIDS, HIV, chemotherapy)
  • Inflammatory diseases

Factors Influencing Duration

The length of disability is influenced by the age and overall health of the individual, the status of their immune system, the existence of chronic underlying medical conditions, deformities of the nose or sinuses, the promptness with which antibiotic therapy was begun, the response to medical therapy and the need for surgical intervention, and the presence of complications.

Medical Codes

ICD-9-CM:
461.0 - Maxillary, Acute Antritis
461.1 - Sinusitis, Frontal
461.2 - Sinusitis, Ethmoidal
461.3 - Sinusitis, Sphenoidal
461.8 - Sinusitis, Acute, Other
461.9 - Sinusitis, Unspecified
473.0 - Chronic Sinusitis, Maxillary; Antritis (chronic)
473.1 - Chronic Sinusitis, Frontal
473.2 - Chronic Sinusitis; Ethmoidal
473.3 - Chronic Sinusitis; Sphenoidal
473.8 - Chronic Sinusitis, Other; Pansinusitis (Chronic)
473.9 - Sinusitis, Chronic, Unspecified

Overview

Sinusitis is inflammation of the mucosal lining of one or more paranasal sinuses that connect to the nasal passageway. The paranasal sinuses comprise four pairs of air-filled chambers above the eyes behind the forehead (frontal sinuses), behind the cheekbones (maxillary sinuses), behind the nose (sphenoid sinuses), and between the eyes at the bridge of the nose (ethmoid sinuses).

Sinusitis can be caused by viral, bacterial, or fungal infection. Contributing factors include viral (such as the common cold) or bacterial infections of the upper respiratory tract, allergies, abnormal anatomical structure of the sinuses or nose, and sinus tract injury. The sinuses normally produce mucus that is cleared through a self-cleaning mechanism: mucus passes through tiny drainage channels into the nose and throat (nasopharynx), where it is swallowed. However, when the mucosal lining becomes inflamed, the small drainage openings to the nose become narrowed and/or blocked. Because mucus cannot drain properly, the sinus cavities fill with mucus, causing uncomfortable pressure (sinus headache) and creating an ideal environment for organisms to multiply and cause infection.

Sinusitis may be acute or chronic. Acute sinusitis typically begins with an acute viral infection that then leads to development of bacterial sinus infection in susceptible individuals. Acute sinusitis varies in severity and may last up to 4 weeks; it may recur several times a year. Sinusitis is considered subacute if an infection lasts up to 12 weeks, and subacute sinusitis may transition to chronic sinusitis (an infection lasting at least 12 weeks).

Acute sinusitis in adults is usually caused by a single aerobic bacterial organism (e.g., Streptococcus pneumoniae, Haemophilus influenzae) (Brook; CDC). Chronic sinusitis is usually caused by multiple bacterial organisms, including Staphylococcus aureus and Staphylococcus epidermidis, which are normal bacterial flora found in the nasal passages. On occasion, anaerobic bacteria and fungi may also be involved with persistent chronic infection.

Although bacterial sinusitis most commonly occurs after an upper respiratory tract viral infection, it can also be caused or aggravated by an abscess of an upper tooth, changes in atmospheric pressure (e.g., airplane flights), mold or fungi, and chemical irritation of the sinuses from toxic fumes such as chlorine gas. Allergies may be associated with chronic inflammation, making individuals more susceptible to bacterial infection. Underlying conditions such as immunodeficiency, uncontrolled diabetes, cystic fibrosis, and inflammatory diseases (e.g., chronic bone inflammation or osteitis) may also predispose an individual to acute or chronic sinusitis.

Immunocompromised individuals, postoperative patients who have had an endotracheal tube passed through the nose, dialysis patients, burn patients, and patients with severe trauma are at greater risk of developing bacterial sinusitis.

Incidence and Prevalence: Sinusitis affects approximately 16% of the population annually. Sinus inflammation is reported by 32 million adults in the US each year (Anand), resulting in 13 million doctor's visits annually (Anand).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Sinusitis can affect individuals of any age and is roughly twice as common in women (20.9%) as it is in men (11.6%) (Anand).

Source: Medical Disability Advisor



Diagnosis

History: Acute and chronic sinusitis are diagnosed mainly by reported symptoms. Individuals may report nasal congestion; presence of thick yellow-green discharge from the nose; pain with tenderness as well as swelling and pressure around the forehead, eyes, nose, or cheeks; toothache; loss of smell; sore throat; poor response to nasal decongestants; recent history of a common cold or allergic rhinitis; and/or headache (especially upon awakening). The headache and facial pain may be located over the infected sinus. Bacterial sinusitis most commonly occurs following a viral infection, and is often associated with symptoms that last longer than 7 to 10 days. A general medical history must include prior or existing conditions, injuries (broken nose, head injuries), surgeries (e.g., tooth extraction) and diseases. It is important to be aware of immunodeficiency, administration of immunosuppressive drugs (chemotherapy), or underlying inflammatory diseases.

Physical exam: Physical examination will include an evaluation of respiratory areas, including 2 procedures that are generally not reliable to definitively diagnose sinusitis: tapping with the fingers (percussion) over the frontal and maxillary sinuses, which may reveal tenderness, and directing a strong light over the sinuses to observe if fluid is present (transillumination of the sinuses). The nasal passage will be examined for purulent discharge and swollen membranes. Ears will be examined for simultaneous serous otitis or otitis media. The throat will be examined for inflammation and signs of mucopurulent drainage. A stethoscope may be used (auscultation) to rule out lung congestion, especially if a cough is present. Body temperature is measured.

Tests: Laboratory tests include a complete blood count (CBC) to check for an elevated white blood cell count that may indicate active infection. A nasal smear may be examined for white blood cells, and nasal drainage is usually cultured to identify bacteria that may be causing infection. The absence of specific bacteria may indicate a virus or fungus as the source of infection, which may be confirmed through additional tests. Sinus x-rays, cranial computed tomography (CT), cranial magnetic resonance imaging (MRI), or nasal endoscopy can confirm sinusitis or thickening of sinus membranes. These tests are not usually done in acute sinusitis, and may be reserved for recurrent or chronic sinusitis.

Source: Medical Disability Advisor



Treatment

The goals of treatment for acute sinusitis and chronic sinusitis flare-ups are to cure the infection, reduce inflammation, and alleviate symptoms. Reestablishing normal clearance of mucus is usually done with medications. Decongestants (oral decongestants, nose drops, or nasal steroid sprays) may be recommended for brief periods of time, usually no more than three days, to shrink nasal and sinus membranes to increase sinus drainage. Antihistamines are used in individuals with underlying allergies. Mucolytic medications or expectorants may be used to thin mucus and facilitate drainage. Over-the-counter analgesics may be used for pain. Increasing fluid intake and using a humidifier will increase moisture in affected sinuses and help thin mucus to increase drainage. Antibiotics are given to treat bacterial infection, typically for 10 to 14 days. On average, adults have two or three colds a year, of which only 2% are complicated by acute bacterial sinusitis, yet antibiotics are prescribed in more than half of the cases (Lancet). Broad-spectrum antibiotics are sometimes prescribed for chronic sinusitis, but reducing inflammation with nasal corticosteroids or other anti-inflammatory medications is often the mainstay of treatment, especially in individuals with asthma, allergic rhinitis, or nasal polyps. Long-term treatment for chronic sinusitis can be challenging; it relies on anti-inflammatory measures and reserves antibiotics for acute flare-ups only.

If sinusitis is unresponsive to medical therapy and is chronic in nature, surgery may be performed to correct an anatomical defect affecting sinus drainage (e.g., deviated septum). Functional endoscopic sinus surgery may be performed under local or general anesthesia to clean and drain the sinuses, to remove diseased tissue and bone to enlarge the natural openings of the sinuses, and to try to restore appropriate drainage/ventilation relations between the nose and sinus cavities.

Source: Medical Disability Advisor



Prognosis

Individuals with uncomplicated acute sinusitis can expect a full recovery and return to work. Since approximately 80% of cases of acute bacterial sinusitis resolve spontaneously without antibiotics, the use of antibiotics adds no additional treatment benefit (Garbutt). Rarely, sinusitis complicated by spread of infection to facial bones or brain will extend treatment times and require a more lengthy recovery. Fungal sinusitis is rare but can spread rapidly and result in death in immunocompromised individuals (e.g., cancer patients, HIV/AIDS patients), in patients with uncontrolled diabetes, or in those undergoing dialysis.

Chronic sinusitis varies in acuity among individuals but requires ongoing long-term treatment for inflammation and periodic treatment for acute flare-ups. Individuals with no significant underlying illnesses may recover completely. Individuals with inflammatory illnesses, compromised immune systems, or allergic conditions are subject to episodes of acute bacterial sinusitis.

Individuals requiring sinus surgery can expect to return to normal activities within 5 to 7 days postoperatively and to achieve full recovery in approximately 4 to 6 weeks. Approximately 95% report satisfaction with the results of their sinus surgery (Kaluskar).

Source: Medical Disability Advisor



Complications

The incidence of complications from acute sinusitis is low, with or without the use of antibiotics. The persistence of bacteria in the sinuses rarely leads to chronic sinusitis, but persistent inflammation will increase the likelihood of a chronic condition and of complications such as spread of infection to the bones of the face (osteomyelitis), the soft tissue of the face (cellulitis), or the brain (brain abscess, or rarely meningitis). Other possible complications include abscess formation and blood clot formation in the cavernous sinus (cavernous sinus thrombosis).

Spread of infection to the eyes, mouth, and brain occurs more often in individuals with depressed immunity from HIV/AIDS or chemotherapy. Individuals with chronic sinusitis who experience recurrent and prolonged bacterial sinus infections may require surgery to improve sinus drainage.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

During a sinus infection, it is important that the individual have access to adequate amounts of fluids. The individual should avoid irritating fumes and smoke or wear a protective mask. Special air filters called high-efficiency particulate filters and electrostatic filters may be helpful to reduce environmental pollutants.

Risk: In an immunocompromised individual, working with heavy public contact, with indigent or incarcerated populations, or in health care settings may place the individual at increased risk of further or recurrent infection. A person with symptom onset within the last 24-48 hours is in a more infectious state and should avoid working in settings with immunocompromised individuals. Some risk can be mitigated by frequent hand washing and wearing gloves or masks.

Capacity: There should be no impact on capacity in individuals with sinusitis.

Tolerance: Individuals may benefit from variable combinations of anti-histamines, decongestants, and nasal sprays to permit greater tolerance in the work environment.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 to 90 days (wide range reflecting anatomic variation as well as individual susceptibility).

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 a clinical history of a cold or rhinitis?
  • Have respiratory tract symptoms been present for 7 to 10 days or longer?
  • Does individual have symptoms suggestive of sinusitis (headache, facial pain, upper toothache, or purulent nasal discharge)?
  • Were the findings on the clinical exam consistent with the diagnosis of sinusitis?
  • Was a nasal culture done?
  • If the diagnosis was uncertain, were conditions with similar symptoms such as allergy or infected teeth ruled out?

Regarding treatment:

  • Was the treatment appropriate for the diagnosis?
  • Were symptoms relieved?
  • Were appropriate antibiotics administered, as indicated?
  • Was surgical intervention needed?

Regarding prognosis:

  • Did the individual have surgery? A deviated septum repair? A functional endoscopic sinus surgery?
  • Did individual have a full recovery?
  • Did individual suffer any complications that may have affected recovery and prognosis?
  • Are there any underlying conditions that may lengthen recovery?

Source: Medical Disability Advisor



References

Cited

Anand, V. K. "Epidemiology and Economic Impact of Rhinosinusitis." Annals of Otology, Rhinology & Laryngology 193 (2004): 3-5.

Brook, Itzhak, et al. "Acute Sinusitis." eMedicine. Ed. Michael Stuart Bronze. 25 Sep. 2014. Medscape. 7 Nov. 2014 <http://emedicine.medscape.com/article/232670-overview>.

CDC. "Acute Bacterial Rhinosinusitis: Physician Information Sheet." CDC. 4 Nov. 2013. Centers for Disease Control and Prevention. 7 Nov. 2014 <http://www.cdc.gov/getsmart/campaign-materials/info-sheets/adult-acute-bact-rhino.html>.

Garbutt, J. M., et al. "Amoxicillin for Acute Rhinosinusitis: A Randomized Controlled Trial." Journal of American Medical Association 307 (2012): 685-692.

Kaluskar, Shashi K., and Shaik I. Basha. "Long-Term Results of Fess - a Random Survey." Indian Journal of Otolaryngology and Head & Neck Surgery 62 3 (2010): 248-251.

Lancet. "Sinusitis and Antibiotics." Lancet Infectious Diseases 12 5 (2012): 355.

Orlandi, Richard R. "Sinusitis." Conn's Current Therapy 2007. Ed. Robert E. Rakel. 59th ed. Philadelphia: W.B. Saunders, 2007.

Source: Medical Disability Advisor






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