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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

Renewal

  • 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

Favourable

  • 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.

Unfavourable

  • 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

Disclaimer

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