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.

Tonsillitis and Adenoiditis


Related Terms

  • Adenoid Hypertrophy
  • Adenotonsillitis
  • Infective Adenoiditis
  • Infective Tonsillitis
  • Pharyngotonsillitis
  • Septic Adenoiditis
  • Septic Tonsillitis
  • Suppurative Adenoiditis
  • Suppurative Tonsillitis
  • Tonsillar Hypertrophy
  • Viral Tonsillitis

Differential Diagnosis

  • Adenoid hypertrophy
  • Lymphoma
  • Pharyngitis
  • Strep throat

Specialists

  • Family Physician
  • General Surgeon
  • Internal Medicine Physician
  • Otolaryngologist
  • Pediatrician

Comorbid Conditions

  • Chronic sinusitis
  • Pharyngitis
  • Severe nasal obstruction

Factors Influencing Duration

Length of disability may be influenced by the underlying cause (bacterial or viral infection), method of treatment (antibiotics or surgery), response to treatment, or the presence of complications (presence of other infections).

Medical Codes

ICD-9-CM:
463 - Tonsillitis, Acute
474.00 - Tonsillitis, Chronic
474.01 - Adenoiditis, Chronic
474.02 - Chronic Tonsillitis and Adenoiditis
474.10 - Hypertrophy of Tonsils and Adenoids; Tonsils with Adenoids
474.11 - Hypertrophy of Tonsils Alone
474.12 - Hypertrophy of Tonsils and Adenoids; Hypertrophy of Adenoids Alone
474.9 - Chronic Disease of Tonsils and Adenoids, Unspecified; Disease (Chronic) of Tonsils (and Adenoids)

Overview

Tonsillitis is an inflammation of the fleshy tissues that lie on either side of the back of the mouth at the top of the throat (pharyngeal or palatine tonsils). These tissues contain cells that are useful in fighting infection.

Inflammation of the tonsils can be caused by many contagious bacteria or viruses, including strains of streptococcus bacteria, adenovirus, influenza virus, Epstein-Barr virus, enterovirus, and the herpes simplex virus. One of the most frequent causes of tonsillitis is group A beta hemolytic Streptococcus pyogenes (GABHS), which is also the cause of strep throat; it is responsible for 30% of childhood tonsillitis and 10% of adult cases (Lauro).

Adenoiditis is an inflammation of the lymphoid tissue at the back of the roof of the mouth (the adenoids). Adenoiditis, or enlarged adenoids (adenoid hypertrophy), is unusual in adults because the adenoids normally shrink and almost disappear as the individual reaches adolescence. Hypertrophy of the adenoids occurs naturally or is caused by chronic inflammation. Chronic adenoid inflammation may cause nose-breathing problems due to their location.

Tonsillitis and adenoiditis may occur at the same time in children.

Incidence and Prevalence: Tonsillitis is a common condition, with nearly all children becoming infected at least once (Shah). Carrier status of GABHS is found in 2.5% to 10.9% of school-age children (Shah).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Children are at a greater risk for both tonsillitis and adenoiditis. The risk is higher in those with a family history of tonsillectomy; in adults, the risk is variable and unspecified.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with tonsillitis may report a sudden onset of a sore throat, painful swallowing, and fever. In addition, the individual may experience headache, loss of appetite, chills, malaise, and swollen lymph nodes in the neck and jaw area.

Individuals with adenoiditis may report chronic or acute pus-like nasal discharge and chronic mouth breathing due to nasal blockage (obstruction). The individual may also experience painful swallowing, snoring, sleep disturbances (sleep apnea and restlessness), and ear infections (otitis media). A history of prior bouts of tonsillitis may be reported (chronic tonsillitis).

Physical exam: Examination of the neck and throat of an individual with tonsillitis reveals swollen, red tonsils, often coated with white areas of exudate if tonsillitis is caused by Streptococcus pyogenes. In some cases, grayish-white membranes and red spots (petechiae) may be seen if tonsillitis is caused by Epstein-Barr virus. The lymph nodes in the neck and jaw area may be swollen and tender, and the neck may be stiff. Signs of dehydration may be seen in the skin and mucosa. Ulcerated areas may be found on the tonsils, suggestive of herpes simplex virus.

A physical exam of an individual with adenoiditis reveals enlarged adenoids and nasal discharge. A rhinoscopy (examination of the nose with a speculum) may be performed.

Tests: A swab of the tonsils may be cultured to determine if the tonsillitis is caused by streptococcal bacteria. An x-ray of the side view of the throat may be taken in individuals who may have adenoiditis.

Source: Medical Disability Advisor



Treatment

Tonsillitis that is caused by a bacterial infection is usually treated with a 10- to 14-day course of antibiotics, given either as a one-time injection or orally. Penicillin is the drug of choice for tonsillitis; for people allergic to penicillin, erythromycin or clindamycin may be prescribed. Supportive treatment includes drinking plenty of fluids, rest, use of a humidifier, and use of over-the-counter medications to relieve pain and/or fever. Tonsillitis that is caused by a viral infection is not treated with antibiotics but may be treated with antiviral medications.

Adenoiditis may be treated with antibiotics if symptoms do not improve after 10 to 12 days.

Surgical removal of the tonsils (tonsillectomy) and adenoids (adenoidectomy) is usually recommended if the tonsils and/or adenoids become chronically infected, if there is an obstruction of the airway, or if the individual experiences excessive snoring or sleep apnea (when breathing momentarily and episodically stops during sleep). These procedures, particularly in adults, can cause severe pain.

Source: Medical Disability Advisor



Prognosis

Most cases of tonsillitis heal well and go away in 7 to 10 days. Bacterial infections usually respond favorably to antibiotic therapy. Symptoms of tonsillitis usually lessen 2 to 3 days after treatment begins. If infections recur frequently, surgical removal of the tonsils and adenoids (tonsillectomy and adenoidectomy) may be advised. This surgery is usually successful.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation therapy is not necessary. The individual should get adequate rest and drink plenty of fluids until the infection clears.

Source: Medical Disability Advisor



Complications

Complications of tonsillitis are rare primarily because of advances in medical and surgical treatment. If left untreated, tonsillitis associated with Streptococcus pyogenes can lead to more serious conditions such as rheumatic fever and possible accompanying cardiovascular disorders, or kidney complications (post-streptococcal glomerulonephritis) that can lead to kidney failure. Other complications of untreated tonsillitis include viral or bacterial throat infections (pharyngitis), dehydration due to difficulty swallowing fluids, difficulty breathing (airway obstruction), and abscesses in other parts of the throat (quinsy or peritonsillar abscess).

Complications of adenoiditis include right-sided heart failure (cor pulmonale), chronic ear infections (otitis media), airway obstruction, and obstructive sleep apnea, in which an individual periodically stops breathing while sleeping.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are not usually associated with this condition unless a tonsillectomy/adenoidectomy has been performed. These procedures are usually done on an outpatient basis, and recovery from surgery usually requires 1 to 2 weeks. A person can return to work 24 hours after starting antibiotic treatment.

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 experience symptoms of sore throat, fever, malaise, and/or purulent nasal discharge, ear infections or snoring?
  • Has a culture and sensitivity been performed to identify the causative organisms and most appropriate antimicrobial therapy?
  • Has diagnosis of tonsillitis and/or adenoiditis been confirmed?
  • If not, have other conditions with similar symptoms, such as strep throat, lymphoma, or other cancers, been ruled out?

Regarding treatment:

  • Has any underlying bacterial infection been treated with the appropriate antibiotics (according to a culture and sensitivity)?
  • If the infection was viral, were antiviral medications warranted?
  • Has the prescribed medication been taken according to instructions?
  • Has surgical intervention been considered (i.e., for chronic infection, or associated snoring or sleep apnea)?
  • With adenoiditis, have symptoms persisted longer than 10 to 12 days? If so, were antibiotics prescribed?

Regarding prognosis:

  • Has the infection persisted despite treatment? If so, has culture and sensitivity been done to identify the causative organism, determine the most effective antibiotic, and to rule out antibiotic-resistant organisms? Would extended therapy or a change in antibiotics be warranted at this time?
  • Was surgery indicated?
  • Did individual experience any complications associated with the infection, such as rheumatic fever, glomerulonephritis, cor pulmonale, or throat abscesses, that could affect recovery and prognosis?
  • Have these complications been addressed in the treatment plan?
  • Does individual have a comorbid condition that may affect recovery, such as severe nasal obstruction or chronic sinusitis?

Source: Medical Disability Advisor



References

Cited

Lauro, Joseph, and Erik D. Barton. "Tonsillitis." eMedicine Health. Eds. Scott H. Plantz, et al. 10 Aug. 2005. WebMD, LLC. 29 Jun. 2009 <http://www.emedicinehealth.com/tonsillitis/article_em.htm>.

Shah, Udayan K. "Tonsillitis and Peritonsillar Abscess." eMedicine. Eds. Ari J. Goldsmith, et al. 22 Apr. 2009. Medscape. 29 Jun. 2009 <http://emedicine.medscape.com/article/871977-overview>.

General

Melio, Frank. "Upper Respiratory Tract Infections." Rosen’s Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 5th ed. St. Louis: Mosby, Inc., 2002. 970-975.

Source: Medical Disability Advisor






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