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not assume that the examinee cannot have sinus trouble. The reason for this is that no one can transilluminate
ICAO Preliminary Unedited Version — October 2008 III-12-23
the sphenoid or ethmoid sinuses.
Few applicants are assessed as unfit because of nasal sinus findings during a routine physical examination.
The aviation examiner must, however, be alert, examine carefully, counsel and advise the examinee. If needed,
the applicant must complete further examinations (X-ray or CT-scan) and treatment before being assessed as
fit for aviation duties.
PATHOLOGICAL CONDITIONS
The common cold
Usually an applicant will state that the symptoms of a cold have been present for just one or two days. There
may be marked nasal obstruction, thick yellow discharge, cough and a slight temperature. Withhold a final
decision until a second examination seven to ten days later. Complications can occur in the paranasal sinuses,
the Eustachian tube, the middle ear, larynx, trachea and bronchi. The common cold can be the direct cause of
aerotitis media, inner ear barotrauma and of aerosinusitis.
Pilots should be advised not to fly when they have a cold or nasal stuffiness.
Allergies
The examiner must be alert for the detection of allergic conditions. Be wary of the person who states, "I have
a little hay fever." During the examination of the nose, ask the examinee, "What nose drops do you prefer?
Have you used any antihistamines?" Individuals with severe allergies should be advised early of the possible
complications of allergic reactions while piloting aircraft; the dangers of medication should also be pointed
out.
The outstanding symptoms of allergic rhino-sinusitis are sneezing, marked nasal obstruction, discharges,
watering of the eyes, and a bothersome itching of the nose.
Asthma is often merely a manifestation of allergy in the lower respiratory tract. A careful pulmonary
examination must be done where a definite allergic rhinitis is noted. Persons with "bronchial asthma"
frequently suffer from infections of the paranasal sinuses.
Aerosinusitis (Sinus barotrauma)
Many pilots have at times been bothered with aerosinusitis. Like aerotitis it is caused by pressure differences
between the sinus and the ambient air. This condition causes headache and at times severe pain over the sinus
involved. Any obstruction to drainage of the sinuses results in absorption of the oxygen, stagnation of the
secretion in the sinus, followed by bacterial growth and the formation of pus. Like aerotitis, aerosinusitis
usually develops during descent from higher altitudes. Aerosinusitis in the sphenoid gives rise to headache in
the back of the head, whereas aerosinusitis located in the other sinuses gives pain near the sinus involved.
Choncha bullosa is a cystic distention in the middle nasal concha (choncha media) with entrapped air, which
in some cases can cause aerosinusitis. Choncha bullosa is usually diagnosed by CT-scanning (see Fig. 12-5).
ICAO Preliminary Unedited Version — October 2008 III-12-24
Fig. 12-5: CT-scan of sinuses showing concha bullosa
Relief can be obtained, usually in minutes, by using a mild nasal vasoconstrictor which will decrease nasal and
Eustachian swelling and oedema. One can assume that a pilot with the above symptoms is taking some form
of medication.
If antibiotics and antihistamines are prescribed and if they are being used, the applicant should be aware of
possible side effects and not fly while under treatment.
THE LARYNX
It is essential that a flight crew member has understandable speech. A husky, rough or croaking type of voice
requires a thorough examination of the larynx. Any abnormality should be noted. If further investigation is
required, the pilot should be assessed as temporarily unfit. An acute laryngitis with hoarseness is frequently
seen and will usually subside when the allied infection clears up.
Chronic laryngitis should make the examiner alert for possible causes. Smoking and excessive use of alcohol
as well as tuberculosis and cancer are frequent aetiological factors. Hoarseness lasting longer than two weeks
demands visualization of the larynx and, if indicated, a biopsy of the larynx, which should be done by an ENT
specialist. If a cancer is found, the pilot must receive proper treatment before being considered for certification.
If treated with radiation, special attention must be paid to any post-radiation swelling in the larynx the
following half year. In addition, the pilot must take the inconvenience of a dry mucosa into account. Frequent
moistening of the mouth becomes necessary, especially in the dry air of airliners.
VESTIBULAR SYSTEM
Spatial disorientation
Few applicants for initial issue of a licence will admit to vertigo or dizziness and disorientation but a careful
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Manual of Civil Aviation Medicine 2(86)
