ENT (ear, nose, and throat) - Hearing Impairment

Guidance for medical examiners when assessing a patient for either a general topic or condition – ENT (ear, nose, and throat) - Hearing Impairment.

See also ENT - General and ENT - Vertigo / Disequilibrium conditions.

Aeromedical implications

Effect of aviation on condition

  • Noise and noise-induced hearing loss

Effect of condition on aviation

  • Miscommunication
    • 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.

Demonstrated stability

  • No more than 10dB interval variability at specific frequencies in applicant where temporary threshold shift is excluded

Risk assessment protocol - information required

New cases

  • 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)
  • Management
    • treatment
  • 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

Indicative outcomes

  • 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.



  • 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.

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/ent-ear-nose-and-throat-hearing-impairment
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