Considerations
Tympanic Membrane (TM) defects occur as a result of infection or trauma. If small, most defects will heal in a number of weeks. Once the defect has healed the TM may be temporarily or permanently weak. Someone with poor Eustachian function may be prone to re-rupture. Small tympanic membrane defects generally do not result in significant hearing loss. If the defect is central, dry and there is no history of ear infection in recent time, there should be no restriction to flying.
Larger TM defects generally result in hearing loss. They may be accompanied by middle ear pathology, such as chronic infection or disruption of the ossicular chain. These lesions need to be excluded. Applicants should be referred for ENT specialist assessment. Tympanoplasty is often indicated.
The ME should carefully examine the TM for the presence of defects, retraction and atelectasis. The attic and postero-superior quadrant require careful examination to exclude a retraction pocket. Such pockets may hide a cholesteatoma. Defects at the circumference of the TM (marginal perforations) can also result in cholesteatoma. In case of any doubt referral to an ENT specialist should be made.
Examination of the nasal function and the Eustachian tube function is an integral part of the ear examination.
Conductive hearing loss is a sign of ear canal obstruction, TM or middle ear disease. It may be caused by Eustachian dysfunction, middle ear infection or effusion, perforation, cholesteatoma, otosclerosis or small bones disruption. All require ENT specialist examination under the microscope.
Information to be provided
- An audiometry assessment report, including bone conduction and tympanometry (expect flat tracing – high volume in case of TM defect) upon the first presentation of an applicant with suspected tympanic membrane or middle ear disease;
- An audiometry assessment report, including bone conduction and tympanometry on subsequent occasions if the condition may have changed or as clinically indicated;
- An ENT specialist assessment report upon the first presentation of an applicant with a suspected tympanic membrane or middle ear disease, other than a small central dry perforation;
- An ENT specialist assessment report if there is active disease or the condition may have progressed;
- An ENT specialist assessment report and all previous ENT specialist reports upon the first presentation if a stapedectomy has ever been performed;
- An ENT specialist assessment report and all previous ENT specialist reports upon the first presentation, and subsequently at regular intervals if a mastoidectomy has ever been performed.
- An ENT specialist assessment report and all ENT specialist reports upon the first presentation if any other relevant ear surgery has ever been performed, unless the surgery was uncomplicated myringotomy or ventilation tubes placement in childhood.
Disposition
- An applicant with a central, small, dry tympanic membrane defect may be assessed as having a condition that is not of aeromedical significance;
- An applicant with a central, moderate size, dry tympanic membrane defect may be assessed as having a condition that is not of aeromedical significance if there is no history of infection in recent years, satisfactory hearing and an ENT specialist has advised on absence of middle ear disease;
- An applicant with tympanic membrane retraction or attic retraction pocket may be assessed as having a condition that is not of aeromedical significance only if an ENT specialist has advised on the absence of cholesteatoma and on normal Eustachian tube function – Surveillance by ENT specialist reviews should be considered.
- A Class 1 & 2 applicant with persistent Eustachian tube dysfunction should be assessed as having a condition that is of aeromedical significance;
- An applicant with cholesteatoma should be assessed as having a condition that is of aeromedical significance;
- An applicant who has undergone any form of mastoidectomy should be assessed as having a condition that is of aeromedical significance;
- An applicant who has undergone stapedectomy should be assessed as having a condition that is of aeromedical significance; however;
- An applicant who has undergone stapedectomy more than two years previously, and who has been previously assessed favourably under the flexibility process, may be assessed as having a condition that is no longer of aeromedical significance if that applicant has remained free of any symptoms of vertigo or complications and has satisfactory hearing under those guidelines.
