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– Speech in noise test......................................................................................III-12-19
Types of hearing loss ............................................................................................III-12-20
– Monaural loss...............................................................................................III-12-20
– Presbyacusis.................................................................................................III-12-20
Hearing aids...........................................................................................................III-12-21
Nose and paranasal sinuses .................................................................................III-12-22
Nose ............................................................................................................III-12-22
Paranasal sinuses..............................................................................................III-12-22
Pathological conditions ........................................................................................III-12-23
– The common cold ........................................................................................III-12-23
– Allergies .......................................................................................................III-12-23
– Aerosinusitis (Sinus barotrauma) ................................................................III-12-23
The larynx ............................................................................................................III-12-24
Vestibular system..................................................................................................III-12-24
– Spatial disorientation ...................................................................................III-12-24
History ............................................................................................................III-12-25
Physical examination............................................................................................III-12-26
Caloric testing .......................................................................................................III-12-26
Electronystagmography.......................................................................................III-12-27
– Technique.....................................................................................................III-12-27
References ............................................................................................................III-12-28
ICAO Preliminary Unedited Version — October 2008 III-12-1
INTRODUCTION
This chapter is devoted to the principles of assessment of the otorhinolaryngological system in relation to
aviation duties. The medical examiner should be familiar with the demands likely to be imposed upon hearing,
equilibrium and speech during flight and other aviation duties.
This guidance material does not have any regulatory status and its main purpose is to aid in the
implementation of Annex 1 provisions. It contains methods for comprehensive assessment of applicants in
whom there is a suspicion or overt manifestation of ear, nose and throat pathology. It further serves as a guide
in the assessment of normal, presumably healthy, applicants for aviation personnel licences. The examiner
must make certain that the functions of hearing, equilibrium and speech required for the safe performance of
aviation duties can be reliably carried out by the applicant.
The aim is also eventually to achieve international uniformity of procedures and comparable results in the
assessment of borderline certification cases.
The ENT requirements in Annex 1 are as follows:
6.3.2.25 The applicant shall not possess any abnormality or disease of the ear or related
structures which is likely to interfere with the safe exercise of the applicant’s licence and rating
privileges.
6.3.2.26 There shall be:
a) no disturbance of vestibular function;
b) no significant dysfunction of the Eustachian tubes; and
c) no unhealed perforation of the tympanic membranes.
6.3.2.26.1 A single dry perforation of the tympanic membrane need not render the applicant
unfit.
6.3.2.27 There shall be:
a) no nasal obstruction; and
b) no malformation nor any disease of the buccal cavity or upper respiratory tract which
is likely to interfere with the safe exercise of the applicant’s licence and rating
privileges.
6.3.2.28 Applicants with stuttering or other speech defects sufficiently severe to cause
impairment of speech communication shall be assessed as unfit.
In addition, Annex 1 contains provisions related to hearing test requirements, which are described later in this
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Manual of Civil Aviation Medicine 2(71)
