Hearing Exam: Audiology Test (Item 49) for Pilots Seeking Medical Certification

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide pages 160-163, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

I. Code of Federal Regulations:

Legal Extract

All Classes: 14 CFR § 67.105(a)(b)(c), § 67.205(a)(b)(c), and § 67.305(a)(b)(c)

Ear, nose, throat, and equilibrium standards for a first class airman medical certificate are:
  1. The person shall demonstrate acceptable hearing by at least one of the following tests:

    1. Demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the examiner, with the back turned to the examiner.

    2. Demonstrate an acceptable understanding of speech as determined by audiometric speech discrimination testing to a score of at least 70 percent obtained in one ear or in a sound field environment.

    3. Provide acceptable results of pure tone audiometric testing of unaided hearing acuity according to the following table of worst acceptable thresholds, using the calibration standards of the American National Standards Institute, 1969:

      CFR Part 67 Hearing Standards

      Frequency (Hz)500 Hz1000 Hz2000 Hz3000 Hz
      Better ear (Db)35303040
      Poorer ear (Db)35505060
  2. No disease or condition of the middle or internal ear, nose, oral cavity, pharynx, or larynx that—

    1. Interferes with, or is aggravated by, flying or may reasonably be expected to do so; or

    2. Interferes with clear and effective speech communication.

  3. No disease or condition manifested by, or that may reasonably be expected to be manifested by, vertigo or a disturbance of equilibrium.

II. FAA Recommended Examination Techniques for AMEs

Order of Examinations

  1. The pilot applicant must demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the AME, with the back turned to the AME.
  2. If an applicant fails the conversational voice test, the AME may administer pure tone audiometric testing of unaided hearing acuity according to the above table of worst acceptable thresholds, using the calibration standards of the American National Standards Institute, 1969. If the applicant fails an audiometric test and the conversational voice test had not been administered, the conversational voice test should be performed to determine if the standard applicable to that test can be met.
  3. If an applicant is unable to pass either the conversational voice test or the pure tone audiometric test, then an audiometric speech discrimination test should be administered. A passing score is at least 70 percent obtained in one ear at an intensity of no greater than 65 Db.


  1. Conversational voice test. For all classes of certification, the applicant must demonstrate hearing of an average conversational voice in a quiet room, using both ears, at 6 feet, with the back turned to the AME. The AME should not use only sibilants (S-sounding test materials). If the applicant is able to repeat correctly the test numbers or words, "pass" should be noted and recorded on FAA Form 8500-8, Item 49. If the applicant is unable to hear a normal conversational voice then "fail" should be marked and one of the following tests may be administered:
  2. Standard. For all classes of certification, the applicant may be examined by pure tone audiometry as an alternative to conversational voice testing or upon failing the conversational voice test. If the applicant fails the pure tone audiometric test and has not been tested by conversational voice, that test may be administered. The requirements expressed as audiometric standards according to a table of acceptable thresholds (American National Standards Institute [ANSI], 1969, calibration) are listed above.
  3. Audiometric Speech Discrimination. Upon failing both conversational voice and pure tone audiometric test, an audiometric speech discrimination test should be administered (usually by an otologist or audiologist). The applicant must score at least 70 percent at an intensity no greater than 65 Db in either ear.


  1. Approval. The FAA does not approve or designate specific audiometric equipment for use in medical certification. Equipment used for FAA testing must accurately and reliably cover the required frequencies and have adequate threshold step features. Because every audiometer manufactured in the United States for screening and diagnostic purposes is built to meet appropriate standards, most audiometers should be acceptable if they are maintained in proper calibration and are used in an adequately quiet place.
  2. Calibration. It is critical that any audiometer be periodically calibrated to ensure its continued accuracy. Annual calibration is recommended. Also recommended is the further safeguard of obtaining an occasional audiogram on a "known" subject or staff member between calibrations, especially at any time that a test result unexpectedly varies significantly from the hearing levels clinically expected. This testing provides an approximate "at threshold" calibration. The AME should ensure that the audiometer is calibrated to ANSI standards or if calibrated to the older ASA/USASI standards, the appropriate correction is applied (see table below).
  3. ASA/ANSI. Older audiometers were often calibrated to meet the standards specified by the USA Standards Institute (USASI), formerly the American Standards Association (ASA). These standards were based upon a U.S. Public Health Service survey. Newer audiometers are calibrated so that the zero hearing threshold level is now based on laboratory measurements rather than on the survey. In 1969, the American National Standards Institute (ANSI) incorporated these new measurements. Audiometers built to this standard have instruments or dials that read in ANSI values. For these reasons, it is very important that every audiogram submitted (for values reported in Item 49 on FAA Form 8500 8) include a note indicating whether it is ASA or ANSI. Only then can the FAA standards be appropriately applied. ASA or USASI values can be converted to ANSI by adding corrections as follows:

    ASA / USASI to ANSI Conversion Factors

    Frequency (Hz)500 Hz1000 Hz2000 Hz3000 Hz
    Decibels Added * 14 10 8.5 8.5

    *The decibels added figure is the amount added to ASA or USASI at each specific frequency to convert to ANSI or older equivalent ISO values.

III. FAA Decision Considerations - Aerospace Medical Dispositions

  1. Special Issuance of Medical Certificates. Pilot applicants who do not meet the auditory standards may be found eligible for a SODA (Statement of Demonstrated Ability). An applicant seeking a SODA must make the request in writing to the Aerospace Medicine Certification Division, AAM-300. A determination of qualifications will be made on the basis of a special medical examination by an ENT consultant, a MFT (Medical Flight Test), or operational experience.
  2. Bilateral Deafness. If otherwise qualified, the AMCD may issue a combination medical/student pilot certificate with the limitation


    as well as the limitation


    This will enable the applicant to proceed with training to the point of a private pilot checkride. See Items 25-30.

    When the student pilot's instructor confirms the student's eligibility for a private pilot checkride, the applicant should submit a written request to the AMCD, for an authorization for a MFT. This test will be given by an FAA inspector in conjunction with the checkride. If the applicant successfully completes the test, the FAA will issue a third-class medical certificate and SODA. Pilot activities will be restricted to areas in which radio communication is not required.
  3. Hearing Aids. If the applicant requires the use of hearing aids to meet the standard, issue the certificate with the following restriction:


    Some pilots who normally wear hearing aids to assist in communicating while on the ground report that they elect not to wear them while flying. They prefer to use the volume amplification of the radio headphone. Some use the headphone on one ear for radio communication and the hearing aid in the other for cockpit communications.

This page discussed the Hearing section of the Fight Physical Examination required of pilots.

Reminder: use FlightPhysical.com to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now