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hearing may be allowed to fly only under operational restrictions such as flying with or as a co-pilot only or
with a safety pilot for a two-year observation period. The final decision to remove these restrictions should
then be considered..
It is essential that such a pilot be told of the potential hazards of upper respiratory tract infections or other
conditions which may interfere with ventilation of the middle ear.
A surgical reconstruction referred to as tympanoplasty has been known since 1956. The aims are
twofold - firstly to improve hearing and secondly to close small or large perforations of the tympanic
membrane and rebuild the middle ear structures. Once again a careful history must be obtained.
If the hearing is within Annex 1 provisions, there is no vertigo, and the new tympanic membrane is intact and
ICAO Preliminary Unedited Version — October 2008 III-12-7
free of disease, there should be no restrictions on the applicant's ability to fly.
HEARING ASSESSMENT
Most applicants have fairly good or serviceable hearing. There are, however, borderline cases, and there are
changes in the hearing of applicants with time. Consequently, hearing must be re-examined at specified
intervals. The hearing test requirements and the hearing requirements are detailed in Annex 1 as follows:
6.2.5 Hearing test requirements
6.2.5.1 Contracting States shall use such methods of examination as will guarantee
reliable testing of hearing.
6.2.5.2 Applicants shall be required to demonstrate a hearing performance sufficient for
the safe exercise of their licence and rating privileges.
6.2.5.3 Applicants for Class 1 Medical Assessments shall be tested by pure-tone
audiometry at first issue of the Assessment, not less than once every five years up
to the age of 40 years, and thereafter not less than once every two years.
6.2.5.3.1 Alternatively, other methods providing equivalent results may be used.
6.2.5.4 Applicants for Class 3 Medical Assessments shall be tested by pure-tone
audiometry at first issue of the Assessment, not less than once every four years up
to the age of 40 years, and thereafter not less than once every two years.
6.2.5.4.1 Alternatively, other methods providing equivalent results may be used.
6.2.5.5 Recommendation.— Applicants for Class 2 Medical Assessment should be tested
by pure-tone audiometry at first issue of the Assessment and, after the age of 50
years, not less than once every two years.
6.2.5.6 At medical examinations, other than those mentioned in 6.2.5.3, 6.2.5.4 and
6.2.5.5, where audiometry is not performed, applicants shall be tested in a quiet
room by whispered and spoken voice tests.
Note 1.— The reference zero for calibration of pure-tone audiometers is that of
the pertinent Standards of the current edition of the Audiometric Test Methods,
published by the International Organization for Standardization (ISO).
Note 2.— For the purpose of testing hearing in accordance with the requirements,
a quiet room is a room in which the intensity of the background noise is less than
35 dB(A).
Note 3.— For the purpose of testing hearing in accordance with the requirements,
the sound level of an average conversational voice at 1 m from the point of output
(lower lip of the speaker) is c. 60 dB(A) and that of a whispered voice c. 45dB(A).
At 2 m from the speaker, the sound level is 6 dB(A) lower.
Note 4.— Guidance on assessment of applicants who use hearing aids is
contained in the Manual of Civil Aviation Medicine (Doc 8984).
ICAO Preliminary Unedited Version — October 2008 III-12-8
Note 5.— Attention is called to 2.7.1.3.1 on requirements for the issue of
instrument rating to applicants who hold a private pilot licence.
Class 1 Medical Assessment:
6.3.4 Hearing requirements
6.3.4.1 The applicant, when tested on a pure-tone audiometer, shall not have a hearing
loss, in either ear separately, of more than 35 dB at any of the frequencies 500,
1 000 or 2 000 Hz, or more than 50 dB at 3 000 Hz.
6.3.4.1.1 An applicant with a hearing loss greater than the above may be declared fit
provided that the applicant has normal hearing performance against a background
noise that reproduces or simulates the masking properties of flight deck noise
upon speech and beacon signals.
Note 1.— It is important that the background noise be representative of the noise
in the cockpit of the type of aircraft for which the applicant’s licence and ratings
are valid.
Note 2.— In the speech material for discrimination testing, both aviation-relevant
phrases and phonetically balanced words are normally used.
6.3.4.1.2 Alternatively, a practical hearing test conducted in flight in the cockpit of an
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Manual of Civil Aviation Medicine 2(75)
