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and experience of the examiner. An observation of nystagmus reaction can easily vary from one observer to
the next. This has made a comparison of results unsatisfactory unless the tests were consistently performed by
the same person. Other properties of nystagmus, in addition, could not be properly assessed. Factors such as
amplitude of nystagmus, maximum frequency and speed of the nystagmus beat could not be obtained with any
accuracy. To overcome these difficulties and to eliminate fixation (the examinee’s eyes are kept closed),
electronystagmography/videonystagmography (ENG/VNG) has been developed, whereby one is able to
electronically record the induced nystagmus in a manner similar to recording the cardiac action with
electrocardiography. Also spontaneous and positional nystagmus can be quantified with ENG/VNG.
Technique
A difference in potential exists between the cornea and the retina, the retina being negative and the cornea
being positive. This corneal-retinal potential allows the eye to act as a dipole. The movements of the eye which
occur with nystagmus, cause the corneal-retinal potential to be displaced laterally, causing a recordable change
in the potential at the outer canthus. In the ENG these changes are recorded by electronic equipment and can
be then analysed both qualitatively and quantitatively. In VNG a video camera is fixated on the pupil and
records the movements of the eye. The subject is placed recumbent with the head elevated 30 degrees, thus
placing the horizontal canal in a position for maximum stimulation. Active electrodes are placed lateral to the
outer canthus of the eye with the ground placed on the forehead; the eyes are closed to prevent fixation. The
hot and cold caloric stimuli are applied and the induced nystagmus is automatically recorded by the electronic
apparatus.
Very few aviation medical examiners will have an electronystagmograph in the office. The examiner should,
however, know that these tests are available at aviation medical centres or in well-equipped otology clinics and
audiology centres.
REFERENCES
Rayman, Russell B., et al.: Clinical Aviation Medicine, fourth edition, 2006.
Manual of Civil Aviation Medicine, Joint Aviation Authorities (JAA), 2006.
————————
ICAO Preliminary Unedited Version — November 2009
Part III
Chapter 13. HUMAN IMMUNODEFICIENCY VIRUS (HIV)
TABLE OF CONTENTS
Page
Introduction ....................................................................................................... III-13-1
Background ....................................................................................................... III-13-1
Causative agent .................................................................................................. III-13-1
Transmission ..................................................................................................... III-13-2
Course of HIV infection .................................................................................... III-13-2
Clinical manifestations
of HIV infection .......................................................................................... III-13-3
Evaluation of HIV and disease that
might give rise to incapacitating symptoms ................................................ III-13-5
Current health .................................................................................................... III-13-5
Risk of progression ............................................................................................ III-13-11
Asymptomatic HIV positive cases
and travel vaccination ................................................................................. III-13-14
Appendix.— Suggested protocol for
assessment of HIV disease .......................................................................... III-13A-1
ICAO Preliminary Unedited Version — November 2009 III-13-1
INTRODUCTION
In the introductory chapters of this manual the basic principles for the assessment of an applicant’s
medical fitness for aviation duties are outlined.
In the general medical provisions of Annex 1, the SARPs related to Human Immunodeficiency Virus
(HIV) are the same for all three classes of Medical Assessment – commercial pilots, private pilots, and air
traffic controllers – and state that:
6.3.2.20 Applicants who are seropositive for human immunodeficiency virus (HIV) shall be
assessed as unfit unless the applicant’s condition has been investigated and evaluated in
accordance with best medical practice and is assessed as not likely to interfere with the safe
exercise of the applicant’s licence or rating privileges.
Note 1.— Early diagnosis and active management of HIV disease with antiretroviral therapy
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