APPEALS RESOLUTION OFFICER DECISION
decision number:
20220084
OBJECTING PARTY:
worker
REPRESENTED by:
worker representative
RESPONDENT:
employer
HEARING:
HEARING IN WRITING
HEARD by:
l. diaz, appeals resolution officer
june 21, 2022
ISSUE
The worker objects to the Adjudicator’s March 24, 1999 decision and the December 15, 2020 reconsideration which denied entitlement to bilateral adhesive otitis media as a recurrence.
BACKGROUND
Entitlement in this claim was accepted for barotrauma of the right ear in November 1983 stemming from a September 2, 1983 incident when the worker, a shoveller in a mine, experienced right ear pain due to a change in air pressure while riding to the surface in a 9-shaft cage. There was no lost time as the worker was placed on surface duties for a brief period of time. The worker returned to their regular job duties on October 3, 1983.
In 1993, the worker underwent assessment by Dr. Bains, Ear Noise and Throat (ENT) Specialist, who recommended an E.U.A. (examination under anaesthetic) of the nasopharynx and myringotomy. The worker did not have the procedure performed in 1993, however, they subsequently underwent a bilateral ear E.U.A. of the nasopharynx and myringotomy on August 28, 1998.
In October 1998, the worker requested entitlement to bilateral adhesive otitis media, contending this condition was compatible with the repeated barotrauma exposures with cage descents and ascents.
Adjudicator’s decision
Further to the Adjudicator’s March 24, 1999 decision and December 15, 2020 reconsideration, entitlement to bilateral adhesive otitis media was denied on the basis the worker’s bilateral ear problems were unrelated to the compensable event of September 2, 1983.
Worker’s position
The worker’s representative submitted that the probable cause of the worker’s adhesive otitis was likely the repeated barotrauma exposures with cage descents and ascents. It was their view that the worker suffered from bilateral mixed hearing loss as a consequence of their history of middle ear dysfunction, chronic otitis media, otologic surgery effects, and noise exposure in the industry. It was the worker representative’s position that the opinion of worker’s treating specialist ought to be given more weight than that of the WSIB’s Medical Consultant.
AUTHORITY
Operational Policy Manual Published
02-04-02, Recurrent Disabilities (in effect at the time of the March 1999 decision) May 3, 1991
ANALYSIS
I find the worker does not have entitlement to bilateral adhesive otitis media under the claim, and is therefore not entitled to the claimed recurrence of 1999. In arriving at this decision, I had regard for the arguments presented, the relevant file information, and the applicable Policy.
Policy 02-04-02, Recurrent Disabilities, in effect at the time of the March 24, 1999 decision, records the following in part:
Policy
Recurrences give rise to rights to benefits under the Workers' Compensation Act because they result from a personal injury arising out of and in the course of employment.
A decision-maker will recognize a recurrence when there is obvious medical compatibility or an appropriate combination of medical compatibility and continuity, and an absence of a new
accident.
Medical Compatibility
Decision-makers compare the worker's medical condition following the initial accident to the most recent problems. Similar medical conditions suggest that the subsequent problems may be a result of the original injury. If the medical conditions are not similar or related there is no compatibility and the worker's subsequent problems are not a result of the initial injury.
To assess the similarity of medical conditions, decision makers look to the nature and degree to which the two conditions affect the same or related body parts or functions. In complex cases a medical opinion may be obtained from Unit medical advisors.
Continuity
"Continuity" enquiries are used to establish entitlement for a recurrence when compatibility is not a reliable indicator of the relationship between the original condition and the subsequent problems.
Decision-makers determine whether there have been ongoing
complaints to supervisors/co-workers
symptoms
work restrictions/modifications
medical treatment
or a change in life-style
that establishes a connection between the original condition and subsequent problems.
Further entitlement in a claim as a recurrence is in order when medical compatibility and continuity of complaint are confirmed, provided that there has been no new accident.
In order to determine whether the worker’s bilateral ear problems were medically compatible with the original injury under the claim, I had regard for all file medical reports, however, only the most pertinent medical reports were referenced below.
The file information confirms that Dr. Thakur, WSIB Medical Consultant, reviewed the worker’s file on October 19, 1983, and indicated the following:
This case could be compatible with barotrauma. If the worker has had further medical assessments, then the reports should be obtained for review. Is the worker still on light work? If so, then an ENT will be arranged.
The above opinion was based upon a September 15, 1983 Doctor’s First Report which indicated that the worker sustained a ruptured right tympanic membrane while going up a cage.
The file information does not support the worker complained of any ongoing problems until they were next medically assessed on February 25, 1988. On this date, the worker underwent assessment by an ENT (Ear Nose and Throat) specialist, Dr. Ishak, who recorded the following:
Thank you for asking me to see this pleasant mid-thirty year old man who is complaining of discharge from both ears off and on for many years as long as he can remember (emphasis added). No previous history of middle ear surgery. He also complains of hearing loss bilaterally. No balance problems. He is otherwise in good general health and on no medication. …
(The worker) has secondary stenosis of both ear canals. I really can’t comment on why he has it or how it began. It may be related to chronic infection of the skin of the ear canals and the surface of the tympanic membrane.
A February 5, 1991 report from Dr. Ishak recorded the following with respect to the etiology of the worker’s bilateral hearing problem:
I seen [sic] this mid-thirties year old man in January 1991 because of bilateral otitis externa. He had this problem on and off over 10 or 15 years. Not sure about his hearing.
I’ve seen him in the past in 1988 because of the same problem.
Both ears were cleaned under the microscope. There was severe thickening and lateralization of both tympanic membranes and evidence of stenosis of the ear canal.
He had been seen in follow up since that time on several occasions with microdebridment with no [sic] much improvement. His hearing test shows a slight bilateral conductive loss consistent with the clinical finding. I don’t think I’ll be able to get these ears back to normal.
On March 25, 1998, the worker underwent assessment by Dr. Baines, ENT, who documented that the worker had mild sensorineural hearing loss and serous otitis media. It is noted the worker dated the onset of their problems to 1983 when the worker had a ruptured ear drum. The worker also advised they had not previously had anything wrong with their ears. In Dr. Baines’ ensuing November 5, 1998 report, the diagnosis was confirmed as bilateral adhesive otitis media.
The worker’s representative requested that Dr. Filippone, Otolaryngologist, provide a response to various questions posed. I note the worker’s representative prefaced the June 3, 2020 correspondence to Dr. Filippone by indicating that the worker denied any prior hearing problems or infections. The following was Dr. Filippone’s response:
The probable cause of (the worker’s) adhesive otitis was likely the repeated barotrauma exposures with cage descents and ascents.
The likely reason Dr. Baines performed tube insertion was to mitigate the barometric pressure changes realized in the middle ear (i.e. allow for more comfortable cage travel into the mines and decrease risk of complications of recurrent/chronic middle ear dysfunction).
Middle ear barotrauma can result in ear pain, difficulty hearing, a feeling of fullness in the ear, ear pain with chronic cases potentially resulting in superinfection with cholesteatoma formation and consequent bone erosion with central extension of disease (namely, brain complications). Inner ear barotrauma can result in dizziness, hearing loss and tinnitus. All these results are considered negative health outcomes.
(The worker) suffers from bilateral mixed hearing loss as a consequence of his history of middle ear dysfunction, chronic otitis media, otologic surgery effects and noise exposure in industry.
I also had regard for Dr. Hokim’s March 15, 1999 opinion, which recorded the following:
This gentleman’s problem of bilateral adhesive otitis media with concurrent conductive hearing loss is one which has gone “off and on for many years as long as he can remember” (mrpt Dr. Ishak 02/88). It is unrelated to compensable event, which in any case was unilateral).
Surgery for the tubes is not in order for this claim #.
Vertigo, which developed in approximately 10/98 is not a responsibility of this claim.
PI reassessment is not required.
Medical literature confirms that adhesive otitis media, also known as ‘glue ear’, is a form of chronic otitis media where there is an adhesion of medial ear structures as a result of chronic inflammation – excess fluids accumulate in the middle ear. This condition is more prevalent in children than in adults because the Eustachian tubes in the inner ears of children are very narrow compared to older people, and are therefore more prone to getting blocked with secretions. Adhesive otitis media is usually linked to illnesses such as the common cold, fever, bacterial or viral infection. Allergies due to weather conditions might also triggers adhesive otitis.
In summary, having carefully reviewed the relevant file information, with particular attention to the above reports, I find the worker’s adhesive otitis media has not been shown to be medically compatible with the original injury under the claim.
First, of importance, I note that the original accepted injury under the claim was for a ruptured tympanic membrane to the right ear. However, the condition for which the worker is claiming ongoing entitlement is for a different diagnosis altogether, i.e. adhesive otitis media, and is for both ears, not only the right ear.
Furthermore, although the worker indicated to their representative that they had not had any medical problems prior to their September 2, 1983 injury, I find the contemporaneous medical reports do not support this was the case. In 1988, several years after their workplace injury, the worker was assessed by Dr. Ishak who specifically recorded in their February 25, 1988 report that the worker had ‘complained of discharge from both ears off and on for many years as long as he can remember’, which would suggest that this problem was likely apparent as a young child. I note that Dr. Hokim, WSIB Medical Consultant, also referenced this notation by Dr. Ishak in their March 1999 opinion, and as a result, opined that the worker’s bilateral ear condition was not a responsibility of the claim.
The worker’s representative indicated that Dr. Filippone’s opinion should be preferred to that of the WSIB Medical Consultant as Dr. Filippone had treated the worker for a number of years, had physically assessed the worker (unlike the WSIB Medical Consultant), and was a highly respected ENT in their area.
However, I note the worker’s representative made no comment in relation to Dr. Ishak’s 1988 and 1991 reports, which supported that the worker’s bilateral ear problems significantly pre-dated their 1983 workplace injury. Dr. Ishak also physically assessed the worker and was also an ENT in the Sudbury area. Furthermore, the history obtained by Dr. Ishak was far more contemporaneous than that of Dr. Filippone’s. As a result, I am not persuaded that I should lend greater weight to the opinion provided by Dr. Filippone.
In addition, and of importance, I note Dr. Hokim’s medical opinion was principally based upon the worker’s contemporaneous report to Dr. Ishak that they had suffered from bilateral ear discharge for ‘as long as they could remember’.
It is also not clear that Dr. Ishak’s reports were shared with Dr. Filippone, particularly as the worker’s representative indicated to Dr. Filippone that the worker denied any hearing problems or infections prior to their injury under the claim.
In summary, for all of the reasons indicated above, I do not find the worker’s bilateral adhesive otitis media is medically compatible with their original injury under the claim. As the worker had not met the criteria for entitlement as outlined in Policy 02-04-02, I therefore conclude the worker’s does not have entitlement to a recurrence under the claim.
CONCLUSION
I conclude the worker’s adhesive otitis media is not compatible with their original injury under the claim. Entitlement to the claimed recurrence is therefore denied.
The worker’s objection is therefore denied.
DATED June 21, 2022
L. Diaz
Appeals Resolution Officer
Appeals Services Division