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Ear, nose, throat and related structures

AMA5 Chapter 11 (p 245), applies to the assessment of permanent impairment of the ear (with the exception of hearing impairment), nose, throat and related structures, subject to the modifications set out below. Before undertaking an impairment assessment, users of the Guidelines must be familiar with:

  • the Introduction in the Guidelines
  • chapters 1 and 2 of AMA5
  • the appropriate chapter(s) of the Guidelines for the body system they are assessing.
  • the appropriate chapter(s) of AMA5 for the body system they are assessing.

The Guidelines take precedence over AMA5.

Introduction

6.1 AMA5 Chapter 11 (pp 245–75) details the assessment of the ear, nose, throat and related structures. With the exception of hearing impairment, which is dealt with in Chapter 9 of the Guidelines, AMA5 Chapter 11 should be followed in assessing permanent impairment, with the variations included below.

6.2 The level of impairment arising from conditions that are not work-related needs to be assessed by the medical assessor and taken into consideration in determining the level of permanent impairment. The level at which pre-existing conditions and lifestyle activities, such as smoking, contribute to the level of permanent impairment requires judgement on the part of the clinician undertaking the impairment assessment. The manner in which any deduction for these is applied needs to be recorded in the assessing specialist’s report.

The ear

6.3 Equilibrium is assessed according to AMA5 Section 11.2b (pp 252–55), but add these words to AMA5 Table 11-4, class 2 (p 253): ‘without limiting the generality of the above, a positive Hallpikes test is a sign and an objective finding’.

The face (AMA5, pp 255-59)

6.4 AMA5 Table 11-5 (p 256) should be replaced with Table 6.1, below, when assessing permanent impairment due to facial disorders and/or disfigurement.

Table 6.1: Criteria for rating permanent impairment due to facial disorders and/or disfigurement

Class 1
0-5% impairment of the whole person
Class 2
6-10% impairment of the whole person
Class 3
11-15% impairment of the whole person
Class 4
16-50% impairment of the whole person

Facial abnormality limited to disorder of cutaneous structures, such as visible scars (not hypertrophic or atrophic) or abnormal pigmentation (refer toAMA5 Chapter 8 for skin disorders)

or

mild, unilateral, facial paralysis affecting most branches

or

nasal distortion that affects physical appearance

or

partial loss or deformity of the outer ear.

Facial abnormality involves loss of supporting structure of part of the face, with or without cutaneous disorder (eg depressed cheek, nasal, or frontal bones)

or

near complete loss of definition of the outer ear.

Facial abnormality involves absence of normal anatomic part or area of face, such as loss of eye or loss of part of nose, with resulting cosmetic deformity, combine with any functional loss, eg vision (AMA4 Chapter 8)

or

severe unilateral facial paralysis affecting most branches

or

mild, bilateral, facial paralysis affecting most branches.

Massive or total distortion of normal facial anatomy with disfigurement so severe that it precludes social acceptance

or

severe, bilateral, facial paralysis affecting most branches

or

loss of a major portion of or entire nose.

Note: Tables used to classify the examples in AMA5 Section 11.3 (pp 256-59) should also be ignored and assessors should refer to the modified table above for classification.

6.5 In AMA5 example 11-11 (p 257), add the words ‘visual impairment related to enophthalmos must be assessed by an Ophthalmologist’.

The nose, throat and related structures

6.6 - 6.9 Respiration (AMA5 Section 11.4a, pp 259-61)

6.6 In regard to sleep apnoea (third paragraph of AMA5 Section 11.4a, p 259), a sleep study and an examination by an ear, nose and throat specialist is mandatory before assessment by an approved assessor.

6.7 The assessment of sleep apnoea is addressed in AMA5 Section 5.6 (p 105) and assessors should refer to this chapter, as well as paragraphs 8.8 - 8.10 in Chapter 8 of the Guidelines.

6.8 AMA5 Table 11-6, ‘Criteria for rating impairment due to air passage defects’ (p 260), should be replaced with Table 6.2, below, when assessing permanent impairment due to air passage defects.

Table 6.2: Criteria for rating permanent impairment due to air passage defects

Percentage impairment of the whole person
Class 1a
0-5%

There are symptoms of significant difficulty in breathing through the nose. Examination reveals significant partial obstruction of the right and/ or left nasal cavity or nasopharynx or significant septal perforation.

Class 1
0-10%

Dyspnea does not occur at rest

and

dyspnea is not produced by walking freely on a level surface, climbing stairs freely or performance of other usual activities of daily living

and

dyspnea is not produced by stress, prolonged exertion, hurrying, hill climbing, or recreational or similar activities requiring intensive effort*

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea, bronchi or complete (bilateral) obstruction of the nose or nasopharynx.

Class 2
11-29%

Dyspnea does not occur at rest

and

dyspnea is not produced by walking freely on a level surface, climbing one flight of stairs or performance of other usual activities of daily living

but

dyspnea is produced by stress, prolonged exertion, hurrying, hill climbing, or recreational or similar activities (except sedentary forms)

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea, bronchi or complete (bilateral) obstruction of the nose or nasopharynx.

Class 3
11-29%

Dyspnea does not occur at rest

and

dyspnea is produced by walking freely more than one or two level blocks, climbing one flight of stairs, even with periods of rest, or performance of other usual activities of daily living

and

dyspnea is produced by stress, prolonged exertion, hurrying, hill climbing, or recreational or similar activities

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea or bronchi.

Class 4
50-89%

Dyspnea occurs at rest, although individual is not necessarily bedridden

and

dyspnea is aggravated by the performance of any of the usual activities of daily living (beyond personal cleansing, dressing or grooming)

and

examination reveals partial obstruction of the oropharynx, laryngopharyx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea, and/or bronchi.

Class 5
90%+

Severe dyspnea occurs at rest and spontaneous respiration is inadequate

and

respiratory ventilation is required

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea or bronchi.

* Prophylactic restriction of activity, such as strenuous competitive sport, does not exclude subject from class 1.

Note: Individuals with successful permanent tracheostomy or stoma should be rated at 25% WPI. AMA5 example 11-16 (p 261), ‘Partial obstruction of the larynx affecting only one vocal cord’, is better linked to voice (AMA5 Section 11.4e).

6.9 When using AMA5 Table 11-7 ‘Relationship of dietary restrictions to permanent impairment’ (p 262), the first WPI category is to be 0–19%, not 5–19%.

6.10 - 6.12 Speech (AMA5, pp 262-64)

6.10 Regarding the first sentence of the ‘Examining procedure’ subsection of AMA5 (pp 263–64): the examiner should have sufficient hearing for the purpose- disregard ‘normal hearing as defined in the earlier section of this chapter on hearing’.

6.11 ‘Examining procedure’ (AMA5, pp 263-64), second paragraph: ‘The examiner should base judgements of impairment on two kinds of evidence: (1) attention to and observation of the individual’s speech in the office – for example, during conversation, during the interview, and while reading and counting aloud – and (2) reports pertaining to the individual’s performance in everyday living situations’. Disregard the next sentence: ‘The reports or the evidence should be supplied by reliable observers who know the person well.’

6.12 ‘Examining procedure’ (AMA5, pp 263-64): where the word ‘American’ appears as a reference, substitute ‘Australian’, and change measurements to the metric system (eg 8.5 inches = 22 centimetres).

6.13 - 6.14 The voice (AMA5 Section 11.4e, pp 264-67)

6.13 Substitute the word ‘laryngopharyngeal’ for ‘gastroesophageal’ in all examples where it appears.

6.14 Example 11.25 (AMA5, p 269) ‘Impairment rating’, second sentence: add the words “including respiratory impairment” into the sentence to read ‘Combine with appropriate ratings due to other impairments including respiratory impairment to determine whole person impairment’.

6.15 Ear, nose, throat and related structures impairment evaluation summary

6.15 Disregard AMA5 Table 11-10 (pp 272–75), except for impairment of olfaction and/or taste, and hearing impairment as determined in the Guidelines.