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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.

Vertigo


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
386.10 - Vertigo, Peripheral, Unspecified
386.11 - Benign Paroxysmal Positional Vertigo; Benign Paroxysmal Positional Nystagmus
386.19 - Vertigo, Peripheral, Other and Unspecified; Aural Vertigo; Otogenic Vertigo
386.2 - Vertigo of Central Origin; Central Positional Nystagmus; Malignant Positional Nystagmus
438.85 - Late effects of cerebrovascular disease; Vertigo
780.4 - Dizziness and Giddiness; Light-headedness; Vertigo NOS

Related Terms

  • Objective Vertigo
  • Pathological Vertigo
  • Physiological Vertigo
  • Subjective Vertigo
  • Vertiginous Syndrome

Overview

Though sometimes inaccurately called "dizziness," vertigo occurs because of a disturbance in the system for balance in the body (vestibular system). Vertigo is a unique symptom related to specific diseases of the nervous system (central nervous system: pathologic vertigo) or a mismatch in the body's normal systems of balance and position (peripheral nervous system: physiologic or positional vertigo). Vertigo is a rotating sensation giving individuals the false impression that their surroundings are spinning or moving. Examples of physiologic vertigo are seasickness, carsickness, and height vertigo.

A sudden (acute) attack of vertigo is usually due to inflammation of the semicircular canals of the inner ear (nonspecific labyrinthitis), possibly of viral origin. Generally, the attack is self-limited. Ongoing (chronic) vertigo occurs almost daily and usually indicates the presence of a serious disease.

The principal causes of vertigo are Ménière's disease, adverse reactions to drugs (including gentamicin, anticonvulsant intoxication, and certain antibiotics), toxins (notably alcohol intoxication), vestibular neuronitis, multiple sclerosis, vestibular migraine, an abnormal connection between the inner and middle ear spaces (perilymphatic fistula), and an imbalance created by certain head positions or movement (benign paroxysmal positional vertigo, or BPPV). Head trauma, upper respiratory infection, hypothyroidism, and diabetes may be associated with the disease. Since balance is partially maintained by receptors in the neck that sense position in space, trauma to the neck can also cause vertigo. Tumors can occur on the nerve for hearing in the ear (acoustic neuromas).

Autoimmune disorders such as rheumatoid arthritis, dry eye syndrome (Sjögren's syndrome), ulcerative colitis, Wegener's granulomatosis, scleroderma, allergies, systemic lupus erythematosus, and Cogan's syndrome may cause symptoms including vertigo. Autoimmune damage can be confined to the labyrinth, causing vertigo and hearing loss as isolated symptoms. Steroids and other hormones affect the peripheral vestibular system involved in balance, which may be one mechanism contributing to the symptom of vertigo.

Incidence and Prevalence: Dizziness is the third most common complaint for persons seeking outpatient care. Overall, the prevalence of dizziness, imbalance, and vertigo in the general population is 5% to 10%, rising to 40% for those over age 40 (Hamid).

BPPV is estimated to be the most common single cause of vertigo in the US (Li). Approximately 3,000 acoustic neuromas occur each year in the US. Vertigo is present with migraines in about 30% of individuals (Hamid).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Females may be at slightly greater risk than males for benign paroxysmal positional vertigo (BPPV).

Source: Medical Disability Advisor



Diagnosis

History: The individual's primary complaint usually is a sudden sensation that surroundings are spinning or moving (vertigo). Headache, nausea and vomiting, and blurred vision due to jerking eye movements (nystagmus) are common if inflammation of the semicircular canals of the inner ear (labyrinthitis) is the cause. The individual may report problems after use of prescription or other types of drugs. Vertigo may also occur within 24 hours after alcohol intake. Sudden onset may occur while the individual is lying on one side or looking up, with symptoms sometimes resolving in less than a minute. Movement may cause vertigo. It is important to determine if symptoms are those of true vertigo, or lightheadedness and fainting (syncope).

The individual may complain of vertigo after flying or after a prolonged drive in the mountains. Individuals with vertigo caused by sudden rupture of a part of the inner ear (round window of the cochlea) may report symptoms following intense physical exertion such as calisthenics or scuba diving. Other general complaints may include hearing loss, ringing in the ears (tinnitus), falling, or temporary (transient) blindness.

In vertigo originating from the central nervous system, the individual may report a more gradual onset with less intense symptoms.

Physical exam: An active or resolving upper respiratory infection with runny nose, nasal congestion, sore throat, and cough may be evident. Exam may reveal the presence of jerky eye movements (nystagmus). Individuals may have hearing loss on audiogram, eye movement difficulties, facial weakness, or difficulty speaking. Observations of the individual engaged in heel-to-toe walking and touching the nose or standing while the eyes are closed (Romberg's sign) could reveal an unsteady gait, difficulty maintaining equilibrium, and a poor sense of orientation in space. Special positioning maneuvers designed to bring on symptoms (Dix-Hallpike test and Nylan-Barany maneuvers) may be helpful.

Tests: For definitive diagnosis of the underlying cause of vertigo, tests include audiometry, equilibriometry, brain CT scan, and specific testing of the balancing function of the inner ear (caloric stimulation, electronystagmography and posturography). A rare diagnosis of perilymphatic fistula is confirmed with exploratory perforation of the eardrum (tympanotomy). A vascular analysis (angiography) may be needed to determine possible blood flow abnormalities. Neck x-ray or MRI may be indicated to evaluate for musculoskeletal trauma as a cause for vertigo (cervicogenic vertigo) or acoustic neuroma. Three-dimensional analysis of eye movement helps determine the type of nystagmus (infrared nystagmography), which in turn may localize the neurological abnormality causing the vertigo.

Source: Medical Disability Advisor



Treatment

Treatment involves finding and eliminating the cause of vertigo. For example, cerebellopontine angle tumors may be surgically removed, and autoimmune disorders and multiple sclerosis may be treated with appropriate medications. If no neurologic or metabolic defect can be identified, bed rest for 2 to 3 days is effective as the principal treatment in most cases. For those with benign paroxysmal positional vertigo (BPPV), bed rest often involves maintaining the head in a specific position in order to alleviate symptoms that may occur with position changes. In addition, antivertiginous and/or antinausea drugs may be prescribed. Life style changes, pain relievers, or medications aimed at reducing migraine symptoms may be needed for individuals with headaches; however, eliminating medications with potential vertiginous side effects is a first line of treatment.

Positional vertigo is inconvenient but rarely a serious problem unless the individual's occupation depends on good balance or certain physical maneuvers. In this case, even short episodes of vertigo may be disruptive since the most common treatment is to avoid positions or activities that cause the symptoms.

Individuals with Ménière's disease may be treated with diet or diuretics to reduce fluid in the ears. Decompression chamber therapy also may help restore correct pressure balances in the inner ear. In some conditions, short-term use of steroids may relieve inflammation of nerves in the inner ear. Specific maneuvers or physical therapy may be recommended for certain types of positional vertigo.

Various surgical options may be considered in extreme, unresolved cases of vertigo, including relief of pressure in the inner ear (endolymphatic sac surgery, cochleosacculotomy, and microvascular decompression), removal of certain sensory tissue and nerve fibers (labyrinthectomy), sectioning selected nerves (middle cranial fossa, retrolabyrinthine, retrosigmoid, translabyrinthine), pulling away (avulsion) a selected nerve (singular neurectomy), and sealing the inner ear semicircular canal (posterior semicircular canal occlusion).

Source: Medical Disability Advisor



Prognosis

Acute vertigo is usually self-limited and resolves after several days of bed rest. The prognosis for other types of vertigo varies greatly, depending on the underlying cause. In many cases of chronic vertigo, changes in lifestyle may become necessary, such as avoiding positions of the head or body that aggravate or induce symptoms. Chronic diseases such as autoimmune disorders or multiple sclerosis that fail to resolve may cause continuing episodes of vertigo for an indefinite time. The success rates for various surgical procedures aimed at resolving or relieving the symptoms of more serious forms of vertigo range from 60% to 90%. Permanent hearing loss may accompany these surgical procedures.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Neurologist
  • Otolaryngologist

Source: Medical Disability Advisor



Rehabilitation

Individuals experiencing vertigo are seen by a physical therapist trained in the specialty of vestibular rehabilitation. Once it is determined whether the dizziness and balance problem is an inner ear dysfunction or is located in another area such as the brain's center for balance, the therapist can establish a plan of care to treat the individual appropriately.

Much of the therapy focuses around balance exercises that challenge the individual without stimulating a significant amount of dizziness. Modifications to these exercises may be made by the physical therapist for those individuals who have undergone surgery for a condition causing vertigo or who have suffered from some form of head trauma affecting the body's balance.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications depend on any underlying disease. Surgical treatments of vertigo must be performed carefully, or injury and loss of hearing may result. Additional complications of surgery include infection, slow healing, and allergic reactions to medications.

Local anesthetics associated with diagnosis and/or treatment may cause disruption of the inner ear system, leading to possible damage or hearing loss. Certain autoimmune inner ear diseases, such as Sjögren's syndrome and Cogan's disease, may lead to progressive damage to the inner ear and accompanying hearing loss. Depending on the source of vertigo, temporary (transient) blindness could result. Prolonged treatment using some antivertiginous medications could result in the individual's inability to adapt naturally to changes in the inner ear system, thus leading to long-term problems with balance. Poor balance associated with vertigo may lead to falls and other injuries.

Source: Medical Disability Advisor



Factors Influencing Duration

Duration depends on the type of vertigo, the underlying cause for the vertigo, the individual's age and response to treatment, and the extent, if any, of complications. Acute vertigo is self-limited with a duration of a few days. Chronic vertigo may persist indefinitely.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations require consideration on an individual basis. Work restrictions and accommodations should not be required for acute vertigo because it is a self-limited problem. However, individuals with chronic vertigo may need ongoing work restrictions or accommodations. Positional vertigo could require adaptation of work stations to make sure the individual is not forced to move the head at certain angles. Individuals should avoid tasks requiring good balance or physical maneuvering, such as working at heights or around moving machinery, driving, or operating moving machinery. If the individual experiences permanent hearing loss, other accommodations such as hearing enhancements or amplification may be needed.

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 vertigo, a sensation of rotation, as if the surroundings are spinning or moving, or nonspecific dizziness, which may have a cardiac, metabolic, or other cause?
  • Did the vertigo come on suddenly, suggesting inflammation of the semicircular canals of the inner ear (nonspecific labyrinthitis), or is it chronic, which usually indicates the presence of a serious disease?
  • Has the underlying condition been identified and confirmed?
  • Are additional tests needed, such as audiometry, brain CT, brain MRI, or angiography?

Regarding treatment:

  • Has appropriate symptomatic treatment been given, including bedrest, anti-vertiginous and/or anti-nausea drugs, and pain medication for individuals with headaches?
  • If vertigo symptoms have not resolved after medical treatment or rest, is the individual considered a candidate for surgical intervention?
  • Has individual received surgical treatments or local anesthetics, which can result in hearing loss?
  • Has individual been referred for vestibular rehabilitation?
  • Has treatment with antivertiginous medications been prolonged, resulting in loss of adaptation to changes in the inner ear system, thus leading to long-term balance problems?
  • Are the underlying cause of the vertigo and any complications being treated appropriately?
  • If the diagnosis is Ménière's disease, have diuretics been given to reduce fluid in the ears?
  • Should decompression chamber therapy be considered to help restore pressure balances in the inner ear?
  • Should short-term use of steroids be considered to relieve inflammation of nerves in the inner ear?
  • Would specific exercises be helpful for certain types of positional vertigo?

Regarding prognosis:

  • Has the underlying cause been identified?
  • Is it responding to treatment? Would the individual benefit from evaluation by a specialist (neurologist, neurosurgeon, otolaryngologist, ophthalmologist, neurotologist)?
  • To what extent does vertigo affect daily functioning or individual's ability to perform occupational duties?
  • Would accommodations such as adaptation of workstation or reassignment of occupational duties allow individual to return to work?
  • If individual experiences permanent hearing loss, are accommodations such as hearing enhancements or amplification available?

Source: Medical Disability Advisor



References

Cited

Benson, A. G., et al. "Migraine-Associated Vertigo." eMedicine. Eds. Davin W. Chark, et al. 20 Nov. 2008. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/1158940-overview>.

Benson, B. E., et al. "Posttrauamatic Vertigo." eMedicine. Eds. Jack A. Shohet, et al. 16 Feb. 2009. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/884361-overview>.

Boston, Mark E., and Barry Strasnick. "Inner Ear, Labyrinthitis." eMedicine. Eds. Michael E. Hoffer, et al. 6 Mar. 2008. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/856215-overview>.

Friedman, M., and Mohamed Hamid. "Dizziness, Vertigo, and Imbalance." eMedicine. Eds. Spiros Manolidis, et al. 21 Feb. 2007. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/1159385-overview>.

Hain, T. C. "Acoustic Neuroma." American Hearing Research Foundation. 10 Jun. 2008. 20 Jul. 2009 <http://www.american-hearing.org/disorders/tumors/acoustic_neuroma.html>.

Li, John C. "Inner Ear, Meniere Disease, Surgical Treatment." eMedicine. Eds. Michael E. Hoffer, et al. 3 Sep. 2008. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/856658-overview>.

Li, John. "Benign Positional Vertigo." eMedicine. Eds. Spiros Manolidis, et al. 27 2009. Medscape. 20 Jul. 2009 <http://emedicine.medscape.com/article/1158940-overview>.

Source: Medical Disability Advisor