Implementing Rules

Acceptable Means of Compliance

Guidance Material

MED.B.080 Otorhino-laryngology

Initial Class 1 with Hearing Loss
INITIAL applicants shall not have a hearing loss of more than 35dB at any of the frequencies 500Hz, 1000Hz or 2000Hz, or more than 50dB at 3000Hz, in either ear separately.

Revalidation/renewal Class 1 with Hearing Loss
For only revalidation or renewal, greater hearing loss can be recertificated following demonstrated satisfactory functional hearing ability.

Speech discrimination test or functional hearing test
This test should be based on the following ICAO guidance:
Hearing loss greater than the requirements may be acceptable provided that there is normal hearing performance against a background noise that reproduces or simulates the masking properties of the flight deck noise in the cockpit upon speech and beacon signals.

It is important that the background noise be representative of the noise in the cockpit of the type of aircraft for which the applicant’s licence and ratings are valid. The frequency composition of the background noise is defined only to the extent that the frequency range 600 to 4 800 Hz (speech frequency range) is adequately represented. In the speech material for discrimination testing, both aviation-relevant phrases and phonetically balanced words are normally used. Alternatively, a practical hearing test conducted in communication environment representative of the one for which the certificate holder’s licence and ratings are valid may be used.

The Functional Hearing Test form should be used.

Implementing Rules

Acceptable Means of Compliance

Guidance Material

Hearing Aids
For initial Class 1 applicants, hearing aids are not usually acceptable.

In an applicant who already holds a medical certificate, any type of hearing aid is acceptable for recertification, e.g. bone-anchored or intra-aural.  Following insertion of the hearing aid, a functional hearing assessment must be performed and if satisfactory a return to certification is possible.  A multi-crew restriction may be required for Class 1 applicants.

Note: For many pilots increasing the volume of the head set may be preferable and enhance hearing more than wearing hearing aids.

For removable hearing aids, audiometry, if required, should be undertaken both with and without hearing aids.

Class 2
(a) Hearing
   (1) The applicant should understand correctly conversational speech when tested with each ear at a distance of 2 metres from and with the applicant’s back turned towards the AME.
   (2) An applicant with hypoacusis should be assessed as fit if a speech discrimination test or functional cockpit hearing test demonstrates satisfactory hearing ability.  An applicant for an instrument rating with hypoacusis should be assessed in consultation with the licensing authority.
   (3) If the hearing requirements can be met only with the use of hearing aids, the hearing aids should provide optimal hearing function, be well-tolerated and suitable for aviation purposes.

(b) Comprehensive otorhinolaryngological examination
A comprehensive otorhinolaryngological examination should include:
   (1) history;
   (2) clinical examination including otoscopy, rhinoscopy, and examination of the mouth and throat;
   (3) tympanometry or equivalent;
   (4) clinical assessment of the vestibular system.

Class 2 with Hearing Loss
Class 2 applicants who fail the conversational test at 2m are required to provide specialist medical reports detailing the cause of hearing loss and the results of pure tone audiometry. Functional testing in flight may be necessary.

Functional Hearing Test form

Profound Hearing Loss (Class 2)
Class 2 applicants who are or become completely deaf may be considered for certification with special restriction of ‘SSL’ – ‘no flights to or from airfields where ATC is provided by radio and remain outside controlled airspace’.

Implementing Rules

Acceptable Means of Compliance

Guidance Material

Ear Conditions
A fit assessment can be considered after full recovery from a condition affecting the ear following provision of a satisfactory GP or specialist report.  Complex conditions and Class 1 certificate holders will require an ENT specialist assessment.

If there is incomplete recovery from the condition, evidence that the condition has stabilised for an appropriate period of time is required.  The audiogram standards must be met or a satisfactory functional hearing assessment is required.

Medical reports - ENT

Perforation
Recertification is possible after a minimum period of six weeks following a single dry perforation of non-infectious origin.  A specialist report is required confirming complete healing and the pilot must be pain free.  A satisfactory audiogram is required for Class 1 or Class 2 Instrument Rating (IR) recertification.

Stapedectomy
To ensure full healing, recertification is only allowed a minimum of three months after surgery, subject to a satisfactory specialist report confirming no complications, the absence of dizziness, spontaneous or positional nystagmus and a satisfactory hearing result.

Grommet insertion
This is acceptable for certification at both initial and revalidation/renewal.

Acoustic Neuroma
On diagnosis, the applicant should be made unfit.  If clinical management is a ‘watch and wait’ policy, the applicant can be recertificated to Class 1 OML/unrestricted Class 2.  Follow-up MRI reports should be forwarded to  the AMS.
An applicant with symptoms, or if a decision is made to treat, should be made unfit pending full recovery from symptoms or treatment.

Following surgery, recertification depends on surgical approach, extent of removal and post op symptoms.  If brain has been retracted during operation the risk of seizure should be considered.  Normally, following full recovery,  a fit class 1 OML or unrestricted Class 2 assessment is appropriate.  Can consider unrestricted Class 1 at 12 months post-operatively if the imaging shows complete resection of the tumour and there are no seizures or balance disturbance.
 
Following radiotherapy, certification is possible as Class 1 OML/unrestricted Class 2 on recovery (minimum 4 weeks following completion of treatment).  Unrestricted certification can be considered 1 year after the completion date of radiotherapy, subject to imaging showing complete resection of the tumour and there being no seizures or balance disturbance.

Medical reports - ENT

Implementing Rules

Acceptable Means of Compliance

Guidance Material

Benign Positional Vertigo/Labyrinthitis
In view of the recurrence risk of this condition and the sudden incapacitating nature of the symptoms, the earliest a pilot can be considered for recertification is after they have been symptom-free and off any treatment for at least 4 weeks.  Class 1 holders require an OML for a minimum period of 3 months from recertification.

The use of any medication to treat vestibular symptoms, eg Betahistine is not acceptable for medical certification.

Medical reports - ENT 

Meniere’s Disease
A diagnosis of Meniere’s Disease, untreated or treated is not acceptable for Class 1 or 2 medical initial or recertification.

Implementing Rules

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Guidance Material

   
   (5) sinus dysfunction; 

(e) Aero-medical assessment
   (1) applicants for a class 1 medical certificate with the disturbance of vestibular function shall be referred to the licensing authority;

   (2) fitness of class 2 applicants with the disturbance of vestibular function shall be assessed in consultation with the licensing authority.