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.

Tonsillectomy and Adenoidectomy


Related Terms

  • Adenotonsillectomy
  • T&A

Specialists

  • Otolaryngologist

Comorbid Conditions

Factors Influencing Duration

The severity and type of underlying condition, presence of complications, and the type of procedure can influence the length of disability.

Medical Codes

ICD-9-CM:
28.2 - Tonsillectomy without Adenoidectomy
28.3 - Tonsillectomy with Adenoidectomy
28.6 - Adenoidectomy without Tonsillectomy

Overview

© Reed Group
Tonsillectomy is the surgical removal of the palatine tonsils. Adenoidectomy is the surgical removal of the adenoids. Often these two organs in the throat are removed at the same time. This dual procedure is called an adenotonsillectomy, or a T&A.

The palatine tonsils are masses of tissue on both sides of the back of the throat; the tonsils also include the lingual tonsil beneath the tongue and pharyngeal or adenoid tonsil. The adenoids are tissue found between the nasal airway and the back of the throat. Tonsils and adenoids are lymphoid tissue, part of the body's immune system that recognizes foreign organisms and produces antibodies to combat infection. When tonsils and adenoids become infected, they tend to enlarge and may cause sore throats, more frequent ear infections, difficulty breathing, or obstructed breathing at night (obstructive sleep apnea). Recurrent, chronic, or complicated bacterial infections of the tonsils (tonsillitis) or adenoids (adenoiditis) may lead to the need for a tonsillectomy or adenoidectomy. A serious complication of tonsillitis is a peritonsillar abscess. Untreated tonsillitis caused by group A beta hemolytic Streptococcus pyogenes (GABHS) may lead to rheumatic fever and rheumatic heart disease.

Tonsils and adenoids play a role in fighting infection. Because of the potential value of these tissues, antibiotic therapy and other nonsurgical remedies usually are attempted before surgical procedures are considered. Although most procedures are performed on children, some adults may require surgery, especially for obstructive sleep apnea.

Source: Medical Disability Advisor



Reason for Procedure

A tonsillectomy and/or adenoidectomy is performed to treat recurrent infections (more than 6 episodes per year or 3 episodes per year for more than 2 years) or to treat peritonsillar abscess or malignancy (tonsillar cancer). The procedure also is performed to treat breathing difficulties that are due to enlargement of the tonsils and/or adenoids resulting in obstruction of the nasal airway. If adenoids are enlarged, it may be difficult to breathe through the nose. In adults, this condition can lead to obstructive sleep apnea. Tonsillectomy and/or adenoidectomy also may be recommended for adults when enlarged tonsils and adenoids compromise hearing or lead to chronic bacterial infections that may cause excessive time away from work.

The number of tonsillectomies has declined from 1.4 million performed in 1959 to 260,000 performed in 1987. This trend reflects fewer surgeries performed related to infections and more performed to correct airway obstruction (Drake).

Source: Medical Disability Advisor



How Procedure is Performed

General anesthesia is required for a tonsillectomy and/or adenoidectomy. Children are sometimes sedated pre-operatively, but caution is urged when a child has a history of sleep apnea. Children and adults are assessed for coagulation problems before surgery to screen for disorders that may contribute to hemorrhage during T&A. Some adults also may have pre-operative imaging studies (i.e., x-ray, CT, MRI) to rule out malignancy in a tonsillar mass.

The procedure takes about one hour to perform. The individual usually receives fluids intravenously during the procedure. Methods for dissecting and removing tissue vary. The application of electrical energy (electrical cauterization) is the most common. The tissue also may be removed with laser ablation, harmonic scalpel with vibrating blades, powered cutting instruments (microdebrider), or a wire loop may be used to snare the tissue.

In a tonsillectomy, the mouth is held open while the palatine tonsils, located at the back, upper part of the throat, are removed. The lingual tonsil is left in place. In an adenoidectomy, the adenoid tissue is removed from the part of the throat located behind the nose (nasopharynx). A nasal endoscope may be used to identify the tissue mass prior to excising.

No stitches are needed to close the wounds; however, meticulous intraoperative control of bleeding is essential. Hemostasis is maintained by various methods, including pressure application with surgical sponge, ties, suction cautery, or use of bismuth subgallate. T&A usually is done on an outpatient basis, with roughly 6 hours of observation needed following surgery before the individual goes home. Individuals with a peritonsillar abscess, a history of obstructive sleep apnea, or other medical conditions that require monitoring usually are admitted to the hospital for observation overnight. The individual's diet can be advanced from clear liquids on the day of surgery to soft foods the following day and then to solid food as tolerated. Adequate hydration is essential following surgery. Medications for pain and antibiotics to prevent infection are prescribed. Patients are instructed go to the emergency room immediately for any bright red blood coming from the nose or mouth.

Source: Medical Disability Advisor



Prognosis

T&A is safely performed in most cases with no complications. Initially, the individual will have a sore throat; however, most individuals recover from the procedure rapidly. T&A most often quickly resolves underlying conditions such as chronic tonsillitis, adenoiditis, throat infections, upper airway obstruction, and obstructive sleep apnea. In some children with severe obstructive sleep apnea, the condition may persist after surgery. If the tonsillectomy was performed because of tonsillar cancer, the outlook is more guarded, and additional medical treatment will be necessary.

Source: Medical Disability Advisor



Complications

Postoperative bleeding is the most common complication, occurring in 2% to 3% of individuals, resulting in hemorrhage and death in 1 in 40,000 patients (Drake). It can occur during surgery, immediately after surgery, or within up to 2 weeks after surgery. In rare cases, a blood transfusion may be required. The individual who has difficulty swallowing after a procedure may become dehydrated and may require fluid replacement intravenously. Post-operative airway obstruction is more common in children under age 3, while fluid in the lungs (pulmonary edema) tends to occur in individuals with a long history of sleep apnea. Respiratory complications are reported to develop in 20% to 25% of children and adults undergoing T&A for obstructive sleep apnea ("Surgical Management"). Individuals sometimes have adverse reactions to anesthesia used for the procedure. Vocal changes sometimes occur post-operatively.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In general, no restrictions or accommodations should be necessary once the individual returns to work. If postoperative bleeding or other complications occur, additional surgery may be necessary, and the recovery time may be longer. In some cases, the individual may need to be assigned to work tasks that require minimal use of the voice during recovery. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Source: Medical Disability Advisor



References

Cited

Cummings, Charles W., et al., eds. "Surgical Management. Tonsillectomy or Adenoidectomy." Otolaryngology: Head & Neck Surgery. 4th ed. St. Louis: Mosby, Inc.,

Drake, Amelia, and Michael Carr. "Tonsillectomy." eMedicine. Eds. Ari J. Goldsmith, et al. 2 Oct. 2007. Medscape. 1 Aug. 2009 <http://emedicine.medscape.com/article/872119-overview>.

Source: Medical Disability Advisor






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