ENT (ear, nose, and throat) - Vertigo / disequilibrium

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

See also ENT - General and ENT - Hearing Impairment conditions.

Aeromedical implications 

Effect of aviation on condition

• Pure oxygen effect on middle ear and sinuses
• Adjustment to pressure changes
• High and abnormal G inputs into vestibular apparatus

Effect of condition on aviation

• Overt incapacitation
  • acute pain
  • acute deafness
  • acute disorientation and loss of situational awareness
  • nausea and vomiting
• Distraction due to symptoms.

Approach to medical certification

Based on the condition

• Normal middle ear function and effective equalisation of sinuses
• Normal vestibular function

Based on treatment

• No medication required to enable (1) above

Demonstrated stability

• Pressure equalisation
• Absence of symptoms of vertigo:
  • acute labyrinthitis - 3 months
  • benign positional vertigo - 6 months.

Risk assessment protocol - information required

New cases - specialist report

• Confirmed diagnosis
• Clinical status
  • presenting symptoms
  • current symptoms
  • examination findings
• Investigations conducted (please include scan and audio results as available)
• Management
  • treatment
  • side-effects
  • monitoring
• Comment on stability of condition and likelihood of recurrence
• Follow-up plan.

Renewal - spec report

• Current clinical status
  • symptoms and signs (detail vertigo, triggers)
  • examination findings
• Investigations conducted (please include scan and audio results as available)
• Management
  • treatment
  • side-effects
  • monitoring
• Comment on stability of condition and likelihood of recurrence
• Follow-up plan.

Indicative outcomes

• Stability is critical as acute vertigo during flight presents a similar disorientation hazard to the pilot as inadvertent IFR
• Surgery which might cause acute vertigo must also be considered e.g. an endolymphatic fistula following stapedectomy surgery for otosclerosis

Favourable

• Fully resolved acute labyrinthitis and benign positional vertigo following the defined periods of observation
• Healed eardrums post barotrauma with normal Eustachian tube function

Unfavourable

• Eustachian tube dysfunction
• Meniere’s disease
• Recurrent or undiagnosed vertigo

Pilot and controller information

• Vertigo mandates grounding and must be reported to the DAME
• A specialist opinion detailing the required information is required for all cases of vertigo
• A grounding for up to six months may be required to ensure stability