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


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

Aeromedical Implications 

Effect of aviation on condition

  • Noise & 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 CASR hearing standard:
    • Class 1 & 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


  • Meets CASR 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 & 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


The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer