Ear Exam (General)

The external ear is seldom a major problem in the medical certification of applicants. Otitis externa or a furuncle may call for temporary disqualification. Obstruction of the canal by impacted cerumen or cellular debris may indicate a need for referral to an ENT specialist for examination.

The tympanic membranes should be examined for scars or perforations. Discharge or granulation tissue may be the only observable indication of perforation. Middle ear disease may be revealed by retraction, fluid levels, or discoloration. The normal tympanic membrane is movable and pearly gray in color. Mobility should be demonstrated by watching the drum through the otoscope during a valsalva maneuver.

Pathology (diseases or disorders) of the middle ear may be demonstrated by changes in the appearance and mobility of the tympanic membrane. The applicant may only complain of stuffiness of the ears and/or loss of hearing. An upper respiratory infection greatly increases the risk of aerotitis media with pain, deafness, tinnitus, and vertigo due to lessened aeration of the middle ear from eustachian tube dysfunction. When the applicant is taking medication for an ENT condition, it is important that the Examiner become fully aware of the underlying pathology, present status, and the length of time the medication has been used. If the condition is not a threat to aviation safety, the treatment consists solely of antibiotics, and the antibiotics have been taken over a sufficient period to rule out the likelihood of adverse side effects, the Examiner may make the certification decision.

The same approach should be taken when considering the significance of prior surgery such as myringotomy, mastoidectomy, or tympanoplasty. Simple perforation without associated symptoms or pathology is not disqualifying. When in doubt, the Examiner should not hesitate to defer issuance and refer the matter to the AMCD. The services of consultant ENT specialists are available to the FAA to help in determining the safety implications of complicated conditions.

Unilateral Deafness. An applicant with unilateral cogenital or acquired deafness should not be denied medical certification if able to pass any of the tests of hearing acuity.

Bilateral Deafness. It is possible for a totally deaf person to qualify for a private pilot certificate. When such an applicant initially applies for medical certification, if otherwise qualified, the AMCD may issue a combination medical/student pilot certificate with the limitation “Valid for Student Pilot Purposes Only.” This will allow the student to practice with an instructor before undergoing a pilot check ride for the private pilot’s license. When the applicant is ready to take the check ride, he/she must contact AMCD or the RFS for authorization to take a medical flight test (MFT). Upon successful completion of the MFT, the applicant will be issued a SODA, and an operational restriction will be placed on his/her pilot’s license that restricts the pilot from flying into airspace requiring radio communication.

Hearing Aids. Under some circumstances, the use of hearing aids may be acceptable. If the applicant is unable to pass any of the above tests without the use of hearing aids, he or she may be tested using hearing aids.

FAA Aerospace Medical Disposition Grid for
Item 29. Ears, General