This section provides guidelines to assist Medical Examiners in their assessment of the aeromedical significance of conditions affecting the ears, nose and throat and the upper respiratory system.

The external and middle ear may be affected by functional problems such as Eustachian tube dysfunction leading to inability to equalise pressure in flight, resulting in barotrauma. This may cause pain, acute tympanic membrane perforation and acute vertigo. The integrity of the tympanic membranes may also be affected by trauma or infections which can be acute or chronic. Other conditions of importance are cholesteatoma and otosclerosis. All those conditions may be accompanied by hearing impairment depending on severity.

The inner ear may be affected by damage to the cochlea hair cells from ageing, noise and toxic substances exposure. There may be endolymphatic hydrops, Meniere’s disease or sudden hearing loss of uncertain origin. The vestibular system may be affected by labyrinthitis, vestibular neuronitis, otholiths disruption, and Ménière’s disease, all resulting in vertigo. Finally the acoustic nerve can be compromised by the presence of a Schwannoma. This list is not exhaustive.

The nose and sinuses are commonly affected by chronic inflammation. Nasal obstruction due to septal deformity, turbinate hypertrophy or congestion from infectious or allergic rhinitis are common. Chronic inflammation can result in nasal polyps and sinus meati obstruction. Barotrauma accompanied by severe pain may happen either during ascent or descent. Chronic nasal obstruction may also result in poor sleep or frank obstructive sleep apnoea.

Examination techniques

Examination techniques are described in:

General Direction: Examination Procedures [PDF 1.6 MB]
The ICAO Medical Manual: Chapter 12

In addition to examining the hearing performance of an applicant, it should only take a few minutes for the Medical Examiner to ascertain the absence of ear and nasal dysfunction or pathology.

The examination should include nasal passages, using a nasal speculum or an otoscope fitted with a large ear piece, palpation of regional lymph nodes and mouth and throat examination, keeping in mind possible malignancies.

In case of hearing loss, the Rinne and Weber tests, and, if available, tympanometry (impedance audiometry) will assist the ME in deciding what further investigations are appropriate.