The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the otorhinolaryngology system.
(1) Hearing shall be tested at all examinations.
(i) In the case of class 1 medical certificates and class 2 medical certificates, when an instrument rating is to be added to the licence held, hearing shall be tested with pure tone audiometry at the initial examination and, at subsequent revalidation or renewal examinations, every five years until the age 40 and every two years thereafter.
(ii) When tested on a pure-tone audiometer, 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. Applicants for revalidation or renewal, with greater hearing loss shall demonstrate satisfactory functional hearing ability.
(iii) Applicants with hypoacusis shall demonstrate satisfactory functional hearing ability.
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.
For only revalidation or renewal, greater hearing loss can be recertified following demonstrated satisfactory functional hearing ability.
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.
Functional Hearing Test (PDF) form should be used.
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.
(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:
(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 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 (PDF) form
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’.
Acceptable Means of Compliance
(d) Applicants for a class 1 medical certificate with:
(1) an active pathological process, acute or chronic, of the internal or middle ear;
(2) unhealed perforation or dysfunction of the tympanic membrane(s);
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 to download -
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.
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.
This is acceptable for certification at both initial and revalidation/renewal.
On diagnosis, the applicant should be made unfit. If clinical management is a ‘watch and wait’ policy, the applicant can be recertified 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.
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 4
months from symptom resolution.
The use of any medication to treat vestibular symptoms, e.g. Betahistine is not acceptable for medical certification.
A diagnosis of Meniere’s Disease, untreated or treated is not acceptable for Class 1 or 2 medical initial or recertification.
(h) Air passage restrictions
An applicant with significant restriction of the nasal air passage on either side or significant malformation of the oral cavity or upper respiratory tract may be assessed as fit if ENT evaluation is satisfactory.
(j) Eustachian tube function An applicant with significant dysfunction of the Eustachian tubes may be assessed as fit in consultation with the licensing authority.
(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.
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