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

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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 & 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

Disclaimer

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