Chapter 7 - Ear, Nose and Throat Disorders

 

7.0 Introduction

In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

Table 12.5.5: The Auditory Nerve (Chapter 12 - The Neurological System) should be used to assess both Meniere?s disease, and true vertigo consequent upon a disturbance of vestibular function.

Unless they cause interference with balance, speech, respiration or hearing, the following conditions attract a WPI rating of 0:

• rhinitis;
• sinusitis;
• laryngitis;
• pharyngitis;
• otitis media or externa (whether permanent or intermittent).

If interference with balance, speech, respiration or hearing is present, these conditions attract WPI ratings based on the degree of interference with balance, speech, respiration or hearing as described in the tables in Chapter 7.

7.1 Hearing Loss

Hearing defects are assessed in accordance with the current procedures from Australian Hearing.

Once the binaural percentage loss of hearing has been calculated, it is then converted to a WPI rating.

The calculation for converting the percentage loss of hearing to a WPI rating is:

(Percentage Loss of Hearing)

2

 

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7.2 Tinnitus

Table 7.2 is used to assess impairment arising as a result of tinnitus in the presence of unilateral or bilateral hearing loss.

Table 7.2: Tinnitus

% WPI	Criteria
0	Continuous tinnitus which has nuisance value but can be forgotten or ignored with background noise or a low level noise generator.
5	Severe continuous tinnitus which causes extreme distress, interferes with concentration and is not assisted by a low level noise generator.

7.3 Olfaction and Taste

Only complete loss of olfaction or taste attracts a WPI rating. If the employee is able to detect any odour or taste, even if unable to identify it, the WPI rating is 0.

WPI ratings from this table may not be combined with WPI ratings for the same condition from either Table 12.5.1: Olfactory Nerve (Chapter 12 - The Neurological System), or Table 12.5.4: Facial Nerve (Chapter 12 - The Neurological System).

Table 7.3: Olfaction and Taste

% WPI	Criterion
5	Complete loss of olfaction; or Complete loss of taste.
10	Complete loss of olfaction; and Complete loss of taste.

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7.4 Speech

Table 7.4 below is used to assess impairment resulting from interference with speech from local lesions of the organs of speech.

For the purposes of Table 7.4, 'speech' means the capacity to produce vocal signals that can be heard, understood, and sustained over a useful period of time.

Table 7.4 must not be used to assess speech impairment resulting from a lesion of the central nervous system. In such cases, assessment should be made under Table 12.3.2: Production of Speech and Language Symbols (Chapter 12 - The Neurological System).

WPI ratings from Table 7.4 may not be combined with WPI ratings from Table 12.3.2: Production of Speech and Language Symbols (Chapter 12 - The Neurological System).

If there are two separate conditions (one local, and the other a central nervous system condition) interfering with speech production, speech production should be assessed under both Table 7.4 and Table 12.3.2. The greater value is the WPI rating due to speech impairment from all causes.

WPI ratings from within Table 7.4 may not be combined with each other.

If the major problem is one of audibility, intelligibility, or functional efficiency of speech, the criteria appropriate to the area should be used to assess impairment.

If there are problems in more than one area, each area (audibility, intelligibility, and functional efficiency) should be assessed, and the highest value selected as the WPI rating.

Table 7.4: Speech

% WPI	Criteria
	Audibility	Intelligibility	Functional Efficiency
0	Audible in most situations, although may require effort.	Generally intelligible, although some sounds are difficult and some repetition may be needed.	Speech can be sustained except for slowness and some hesitancy.
10	Audible in quiet situations but problems with audibility in noisy environments.	Intelligible although inaccuracies may be frequent and there are obvious difficulties with articulation.	Speech can be sustained but is often discontinuous, interrupted, hesitant and/or slow.
15	Voice tires rapidly, tends to become inaudible after a few seconds. Volume generally low.	Intelligible to family and close friends but strangers find speech generally unintelligible even with repetition.	Difficulty sustaining speech for more than brief periods even when speaks very slowly.
20	Volume very low. Can whisper or produce volume that can be heard only with difficulty by close listener or over the telephone.	Mostly unintelligible, except for a few words.	Laboured speech. Rate of sustained speech impractically slow.
30	Virtually inaudible.	Unintelligible.	No sustained speech.

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7.5 Air Passage Defects

Table 7.5 assesses permanent impairment relating to defects of the air passages. Impairments of the lower airways, and lung parenchyma, are dealt with in Chapter 2 - Respiratory System.

Permanent tracheostomy, or other respiratory stoma, attracts a permanent WPI rating of 25% which may be combined with other values derived from Table 7.5.

An employee is placed in an impairment category based on the criteria in Table 7.5 below.

Table 7.5 applies only to permanent partial obstruction of one or more of the following structures:

• oropharnyx;
• laryngopharynx;
• larynx;
• trachea.

Table 7.5 does not apply to nasal obstruction. Nasal obstruction is assessed under Table 7.6: Nasal Passage Defects.

Prophylactic restriction of activity, such as sporting activity, does not attract the same WPI rating as dyspnoea on participation in the activity.

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Table 7.5: Air Passage Defects

Criteria	% WPI
	0	10	30	40	50	70	90
Ventilation required.	No	No	No	No	No	No	Yes
Dyspnoea at rest.	No	No	No	No	Yes	Yes (severe)	not applicable
Dyspnoea with dressing or grooming.	No	No	No	Yes	Yes (severe)	not applicable	not applicable
Dyspnoea with walking 200m or climbing 8 steps.	No	No	Yes	not applicable	not applicable	not applicable	not applicable
Dyspnoea with hurrying, hill climbing or sporting activity.	No	Yes	not applicable	not applicable	not applicable	not applicable	not applicable

7.6 Nasal Passage Defects

Table 7.6 applies only to nasal obstruction.

Table 7.6: Nasal Passage Defects

% WPI	Criterion
3	Continuous nasal obstruction of sufficient severity to cause mouth breathing at rest.

 

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7.7 Chewing and Swallowing

Table 7.7 below is used to assess impairment resulting from facial muscle damage or loss, dental and oral problems, and temporomandibular joint dysfunction.

WPI ratings derived from Table 7.7 may be combined with WPI ratings derived from Table 8.4: Surgically Created Stomas (Chapter 8 - The Digestive System).

For the same condition, WPI ratings derived from Table 7.7 may not be combined with WPI ratings from Table 12.5.6: The Glossopharyngeal, Vagus, Spinal Accessory and Hypoglossal Nerves (Chapter 12 - The Neurological System).

Table 7.7: Chewing and Swallowing

% WPI	Criteria
0	No interference. Food of any desired type may be eaten without difficulty.
2	Very tough or hard food has to be avoided but diet is otherwise as desired.
5	Diet is limited to soft foods.
10	Diet is limited to pureed foods.
20	Diet is limited to liquid foods.
40	No oral ingestion of food or fluid is possible. Food can only be ingested by means of a nasogastric, gastrostomy, oesophagostomy or other tube.