Guidance for medical examiners when assessing a patient for either a general topic or condition – ENT (ear, nose, and throat) - Hearing Impairment.
Effect of aviation on condition
- Noise and noise-induced hearing loss
Effect of condition on aviation
- between crew
- between aircraft or controllers
- Missed auditory alerts (stall warning etc.).
Approach to medical certification
Based on the condition
- Known diagnosis (progressive asymmetric hearing loss of 20dB or more requires further investigation)
- No adverse sequelae (e.g. vertigo, nausea) or co-morbidity (e.g. tumour)
Based on treatment
- Hearing aid and cochlear implant - meets Civil Aviation Safety Regulations 1998 hearing standard:
- Class 1 and 3: 35 dB at any of the frequencies of 500 Hz, 1 000 Hz or 2 000 Hz and 50 dB at 3 000 Hz
- Class 2: Conversational voice test (CVT) at 2 metres from applicant
- or if not, satisfactory operational test.
- No more than 10dB interval variability at specific frequencies in applicant where temporary threshold shift is excluded
Risk assessment protocol - information required
- Confirmed diagnosis
- Clinical status
- presenting symptoms
- current symptoms
- examination findings
- Operational practice
- hearing aid or cochlear implant used in flight without headset
- headset used without hearing aid
- headset used with hearing aid or cochlear implant
- Investigations conducted (please include scan and audio results as available)
- pure tone audiogram
- speech audio (90% correct at up to 90dB or less in either ear)
- tympanometry (where appropriate)
- Comment on stability of condition and likelihood of deterioration
- follow-up plan
- Operational Flight Test
- if using cochlear implants or hearing aids in flight
- if failed speech audiometry.
- Specialist report where indicated
- Audiograms - annually
- Operational flight test - every 5 years OR with change of hearing aid / headset / cochlear implant / aircraft type
- Certification is possible with hearing aids or cochlear implant if hearing meets standards
- An operational in-flight test may be required in the aircraft that is commonly operated
- fail pure tone and speech discrimination tests
- use hearing aids or cochlear implant in-flight / controlling.
- Meets Civil Aviation Safety Regulations 1998 hearing requirements:
- 67.150 1.30
- 67.155 2.29
- 67.160 3.28
- Hearing aids or cochlear implant if demonstrated satisfactory in-flight test.
- Reliance upon hearing aids when unproven usability with a headset (which may be required in an emergency for audibility)
- Undiagnosed asymmetrical hearing loss
Pilot and controller information
- Information regarding hearing conservation can be found on the Safe Work Australia website.
- Active noise reduction headsets are useful for improving speech discrimination in the cockpit environment / but do not provide hearing protection superior to passive hearing protection
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The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.