Nose portion of FAA Eye Exam for Pilot Medical Certification

Page Contents
Relevant FAA Form 8500-8 Entry Number(s)
26
Description
Nose and Nasal Passages-- FAA Exam Instructions for Pilots Seeking Medical Certification
FlightPhysical's Staff Take Home Message

Examiner will primarly focus on:

  • Evidence of Allergic Rhinitis (Hay Fever)
  • Obstructions of sinus openings

AME Instructions for the Exam

Grid

7. Nose Examination

The nose will be examined for the presence of polyps, blood, or signs of infection, allergy, or substance abuse. The AME should determine if there is a history of epistaxis or anosmia. Polyps may cause airway obstruction or sinus blockage. Infection or allergy may be cause for obtaining additional history.

FlightPhysical's Staff Take Home Message

This is a hotly debated topic likely to change. From footnote #1 on page 49 (2014 AME Guide): Hay fever controlled solely by desensitization without requiring antihistamines or other medications is not disqualifying. Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking an antihistamine.  The Examiner should document this in Item 60: AME Comments on History and Findings.  However, non-sedating antihistamines loratadine or fexofenadine may be used while flying, after adequate individual experience has determined that the medication is well tolerated without significant side effects.

FAA Aerospace Medical Disposition Grid for the Nose

DISEASE/CONDITION

CLASS

EVALUATION DATA

DISPOSITION

Obstruction of sinus ostia, including polyps, that would be likely to result in complete obstruction

All

Submit all pertinent medical information and current status report

Requires FAA Decision

Evidence of severe allergic rhinitis1

All

Submit all pertinent medical information and current status report

Requires FAA Decision

1Hay fever controlled solely by desensitization without requiring antihistamines or other medications is not disqualifying. Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking an antihistamine. The Examiner should document this in Item 60: AME Comments on History and Findings. However, non-sedating antihistamines loratadine or fexofenadine may be used while flying, after adequate individual experience has determined that the medication is well tolerated without significant side effects.

Relevant Code of Federal Regulations Statutory Guidance

Test CFR for DECON formating
Guide for Aviation Medical Examiners – Version 12/03/2025

NOSE - Decision Considerations

ALLERGIES or ANAPHYLAXIS

(Allergic Rhinitis; Seasonal Allergic Rhinitis; Hay fever) - All Classes (Updated 08/28/2024)

Disease/Condition Evaluation Data Disposition

A. Allergies controlled by acceptable medications (single or in combination)

  • Allergy shots/Sublingual Immunotherapy (SLIT)
  • Epi pen is prescribed

The AME should inquire if the applicant has ever experienced any barotitis ('ear block'), barosinusitis ('sinus block'), alternobaric vertigo ('dizziness'), difficulty breathing, rashes, or any other localized or systemic symptoms that could interfere with aviation safety.

If the AME can determine:

  • The condition is under control;
  • Current medications are acceptable;
    • See the Pharmaceuticals Section, Allergy - Antihistamine & Immunotherapy Medication.
  • Any no fly time is discussed with the individual; AND
  • No symptoms that would interfere with flight or safety related duties:
ISSUE

Annotate this in Block 60.

Warn for any required "no fly" time for conditionally acceptable (Sedating) Antihistamine Medications.

If not addressed in the progress note or AME notes, the individual may be asked to provide information to the FAA.

B. Allergies indicated by:

  • Chronic or repeated steroid treatment or
  • Reaction requiring urgent medical intervention
  • Airway closure
  • Urticaria requiring treatment

Submit the following for FAA review:

A current, detailed Clinical Progress Note generated from a clinic visit with the treating allergist, ENT, or pulmonologist no more than 90 days prior to the AME exam. It must include:

  • A detailed summary of the history of the condition;
  • Current medications, dosage, and side effects (if any);
  • Physical exam findings; results of any testing performed;
  • Diagnosis;
  • Assessment and plan;
  • Prognosis; and follow-up.
DEFER

Submit the information to the FAA for a possible Special Issuance.

C. History of anaphylaxis or allergic reactions requiring use of epi-pen

After using an epi-pen or similar, the individual should follow up with their treating physician before returning to flight or safety related duties.

Submit the following for FAA review:

A current, detailed Clinical Progress Note generated from a clinic visit with the treating allergist, ENT, or pulmonologist. It should verify the cause of the anaphylaxis or allergic reaction, likelihood it will re-occur and if it were to re-occur, how severe.
DEFER

Submit the information to the FAA for a possible Special Issuance.

ANOSMIA*

All Classes (Updated 06/29/2022)

Disease/Condition Evaluation Data Disposition

A. KNOWN etiology

Including COVID-19 infection

If due to trauma associated with traumatic brain injury, tumor removal, etc., review that section for additional information or required recovery periods.

No evaluations or follow-up needed if the AME can determine the condition is benign and the pilot has no other condition(s) that would interfere with flight duties:

Discuss with the pilot:

  • This condition may cause an inability to receive early warning of fuel leaks, exhaust fumes, or a fire (prior to visible smoke).
  • Importance of using of a carbon monoxide (CO) detector (not a spot detector) in all aircraft flown that have an internal combustion engine.
  • CO is odorless and tasteless; however, it is frequently accompanied by exhaust fumes that can be detected by smell. Encourage the pilot to ask someone else to verify the absence of fuel fumes in the cabin prior to flight.
ISSUE

Annotate this information in Block 60.

For any identified underlying condition(s), see that section.

B. UNKNOWN (or uncertain) etiology

For ANY duration.

Submit the following to the FAA for review:

  • The most recent detailed Clinical Progress Note (actual clinical record) from an otolaryngologist (ENT).
  • It should include a summary of the history of the condition or diagnosis, current medications, clinical exam findings, results of any testing performed, diagnosis, assessment, plan (prognosis), and follow-up.
  • It must specifically include etiology, if found.
DEFER

Submit the information to the FAA for a possible Special Issuance.

Follow up Issuance will be per the airman's authorization letter.

*Anosmia - partial or complete loss of smell. ENT evaluation required as some cases may be due to nasal polyps or nasal growth (tumor) which could be aeromedically significant.

This "nose relevant" excerpt is from of the Guide for Aviation Medical Examiners verified 24 Jan 2026 and should be used in conjunction with current FAA regulations and guidance.

References:
FAA AME Guide Version 12/03/2025