AME PHYSICAL EXAMINATION INFORMATION AND DISPOSITION TABLES

Items 25-48 of FAA Form 8500-8

Aerospace Medical Dispositions

(Updated 3/25/2026)

Condition Not Listed

All Classes

(Updated 03/25/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. AME determines the individual isNOT at increased riskfor sudden or subtle incapacitation.	When a diagnosis or condition is not listed in the disposition tables, the AME should assess whether the condition or its treatment could lead to sudden or subtle incapacitation.After reviewing the condition and submitted reports, document the rationale for issuance in Item 60 and upload supporting documentation. The FAA may request additional evaluation data.If uncertain, the AME may wish to contact AMCD or RFS and discuss.	ISSUEand explain rationale in Item 60.
B. AME determines the individualIS at increased riskfor sudden or subtle incapacitation.	Medical certificates must not be issued to an individual with medical condition(s) that requires deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS.To help expedite the review process, submit the following to the FAA for review:• Most recent detailed Clinical Progress Note(s)• Results of recent testing already performed pertinent to the condition• Any related treatment recordsAfter reviewing this documentation, the FAA may request additional evaluation data.	DEFERUpload copies of any documentation/reports to the FAA for review.Explain in Item 60 what aspect or concern caused the deferral.

ITEMS 25-30. Ear, Nose, and Throat (ENT)

I. Code of Federal Regulations

All Classes: 14 CFR 67.105(b)(c), 67.205(b)(c), and 67.305(b)(c)

(b) No disease or condition of the middle or internal ear, nose, oral cavity, pharynx, or larynx that -

II. Examination Techniques

Otitis externa or a furuncle may call for temporary disqualification. Obstruction of the canal by impacted cerumen or cellular debris may indicate a need for referral to an ENT specialist for examination.

The tympanic membranes should be examined for scars or perforations. Discharge or granulation tissue may be the only observable indication of perforation. Middle ear disease may be revealed by retraction, fluid levels, or discoloration. The normal tympanic membrane is movable and pearly gray in color. Mobility should be demonstrated by watching the drum through the otoscope during a valsalva maneuver. See Outer Ear Abnormalities.

The same approach should be taken when considering the significance of prior surgery such as myringotomy, mastoidectomy, or tympanoplasty. Simple perforation without associated symptoms or pathology is not disqualifying. When in doubt, the AME should not hesitate to defer issuance and refer the matter to the AMCD. The services of consultant ENT specialists are available to the FAA to help in determining the safety implications of complicated conditions. See Middle Ear Abnormalities.

The student may practice with an instructor before undergoing a pilot check ride for the private pilot’s license. When the applicant is ready to take the check ride, he/she must have an authorization to take a medical flight test (MFT) from either RFS/AMCD. Upon successful completion of the MFT, the applicant will be issued a SODA and an operational restriction will be placed on his/her pilot’s license that restricts the pilot from flying into airspace requiring radio communication.

III. Aerospace Medical Disposition

The Aerospace Medical Disposition Tables list the most common conditions of aeromedical significance and course of action that should be taken by the AME as defined by the protocol and disposition in the table.

ITEM 25. Head, Face, Neck, and Scalp

HEAD, FACE, NECK, AND SCALP

NOSE

ALLERGIES or ANAPHYLAXIS;

• (Allergic Rhinitis; Seasonal Allergic Rhinitis; Hay fever)
• All Classes
• (Updated 08/28/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Allergies controlled by acceptable medications (single or in combination)Allergy shots/Sublingual Immunotherapy (SLIT)Epi pen is prescribed	The AME should inquire if the applicant has ever experienced any barotitis (‘ear block’), barosinusitis (‘sinus block’), alternobaric vertigo (‘dizziness’), difficulty breathing, rashes, or any other localized or systemic symptoms that could interfere with aviation safety.If the AME can determine:• The condition is under control;• Current medications are acceptable; o See the Pharmaceuticals Section, Allergy - Antihistamine & Immunotherapy Medication.• Any no fly time is discussed with the individual; AND• No symptoms that would interfere with flight or safety related duties:	ISSUEAnnotate this in Block 60. Warn for any required "no fly" time for conditionally acceptable (Sedating) Antihistamine Medications.If not addressed in the progress note or AME notes, the individual may be asked to provide information to the FAA.
B. Allergies indicated by;• Chronic or repeated steroid treatment or• Reaction requiring urgent medical intervention• airway closure• urticaria requiring treatment	Submit the following for FAA review:A current, detailed Clinical Progress Note generated from a clinic visit with the treating allergist, ENT, or pulmonologist no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings; results of any testing performed;• diagnosis;• assessment and plan;• prognosis; and follow-up.	DEFERSubmit the information to the FAA for a possible Special Issuance.
C. History of anaphylaxis or allergic reactions requiring use of epi-pen	After using an epi-pen or similar, the individual should follow up with their treating physician before returning to flight or safety related duties. Submit the following for FAA review:A current, detailed Clinical Progress Note generated from a clinic visit with the treating allergist, ENT, or pulmonologist. It	DEFER Submit the information to the FAA for a possible Special Issuance.
	should verify the cause of the anaphylaxis or allergic reaction, likelihood it will re-occur and if it were to re-occur, how severe.

• ANOSMIA*
• All Classes
• (Updated 06/29/2022)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. KNOWN etiologyIncluding COVID-19 infectionIf due to trauma associated with traumatic brain injury, tumor removal, etc., review that section for additional information or required recovery periods.	No evaluations or follow-up needed if the AME can determine the condition is benign and the pilot has no other condition(s) that would interfere with flight duties:***************************************** *** Discuss with the pilot:• This condition may cause an inability to receive early warning of fuel leaks, exhaust fumes, or a fire (prior to visible smoke).• Importance of using of a carbon monoxide (CO) detector (not a spot detector) in all aircraft flown that have an internal combustion engine.• CO is odorless and tasteless; however, it is frequently accompanied by exhaust fumes that can be detected by smell. Encourage the pilot to ask someone else to verify the absence of fuel fumes in the cabin prior to flight.	ISSUE Annotate this information in Block 60. For any identified underling condition(s), see that section.
B. UNKNOWN (or uncertain) etiologyFor ANY duration.	Submit the following to the FAA for review:• The most recent detailed Clinical Progress Note (actual clinical record) from an otolaryngologist (ENT).• It should include a summary of the history of the condition or diagnosis, current medications, clinical exam findings, results of any testing performed, diagnosis, assessment, plan (prognosis), and follow-up.• It must specifically include etiology, if found.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance will be per the airman’s authorization letter.

*Anosmia-partial or complete loss of smell.

ENT evaluation required as some cases may be due to nasal polyps or nasal growth (tumor) which could be aeromedically significant.

ITEM 27. Sinuses

SINUS CONDITIONS

SINUSITIS(Acute or Chronic infection; Deviated Nasal Septum); SINUS OBSTRUCTION (Nasal Cysts; Nasal Polyps; or Sinus Tumor)

All Classes

(Updated 09/25/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Acute infection(s) from any cause requiring medication(s) or notORDeviated nasal septum (not causing obstruction) corrected or notNote: Recurrent, isolated infections which clear can be followed under Row A.	If the AME can determine the condition has resolved without sequelae with no symptoms or current problems that would interfere with flight duties:Notes: If the airman is currently on antibiotics or symptomatic, the treatment course should be completed before medical certification can be considered.Verify medications listed are acceptable. 61.53 applies.Pilots should not fly with a “cold” or viral upper respiratory tract infection, or with the condition of rhinosinusitis.	ISSUEAnnotate this information in Block 60.
B. Chronic or severe (hospitalized for infection)ORAffected by barometric changesORSinus Obstruction from nasal polyps or cysts, tumor, anatomic (deviated nasal septum)	If the AME history and physical exam confirm the condition is chronic, severe, or symptomatic, the airman should not fly until resolved.Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ENT (preferred) or allergist no more than 90 days before the AME exam. It must include:• A detailed summary of the history of the condition.• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up.	DEFER Submit the information to the FAA for a possible Special Issuance.
	2. Personal statement discussing symptoms, severity, how often they occur, and treatment used, any prior surgery or trauma. 3. Sinus CT imaging (report) already performed; 4. Results of evaluation(s) for underlying conditions such as polyps, ciliary dysmotility syndrome, autoimmune disease, immune suppression, or anatomic abnormalities;Pilots should NOT fly with a "cold" or viral upper respiratory tract infection, or with the condition of rhinosinusitis.

NOTE: For Sinus Obstruction due to tumor, see that section

ITEM 28. Mouth and Throat

Palate: Extensive adhesion of the soft palate to the pharynx Submit all pertinent medical information and a current, detailed Clinical Progress Note.

See Protocol for Obstructive Sleep Apnea Requires FAA

Decision

SPEECH IMPEDIMENT, STUTTERING, OR MECHANICAL CONDITIONS (from surgery or trauma)

All Classes

(Updated 08/28/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.ResolvedORDoes not impair voice communication.	If the AME can determine the condition has resolved without sequelae with no symptoms or current problems that would interfere with flight duties:• Communication needed for flight (emergency procedures;• Effective communication with air traffic control; and• Crew-cockpit communication).	ISSUEAnnotate this information in Block 60.
B. Condition, including stuttering, that would impair voice communication	Submit the following for FAA review: 1. A current, detailed Clinical Progress Note generated from a clinic visit with a speech-language pathologist no more than 90 days before the AME exam. It must include:• Detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment;• Plan (prognosis); and• Follow-up. 2. It must specifically include the cause for stuttering and the intelligible their speech is.• Stuttering Severity Index for those who stutter;• Speech Fluency/Intelligibility test for those with mechanical problems; 3. Any testing deemed necessary or already performed by the treating provider.The speech-language pathologist or AME should describe any functional limitations that could affect the pilot's ability to operate aircraft controls or communicate with other pilots or ATCS.	DEFERAME should comment on how well they can communicate.Submit the information to the FAA for a possible Special Issuance.

ITEM 29. Ears, General

• COCHLEAR IMPLANT (CI)
• All Classes
• (Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. If the CI was placed in an adult to improve speech discrimination and sound localization (usually seen in older adults)ORSingle Sided Deafness (SSD)Note: Pilots with a CI should fly with a spare processor and extra batteries.	If the AME can determine:• The individual can pass the hearing requirements with the CI turned OFF (i.e., SSD which passes hearing with the other ear); and• No symptoms or current problems that would interfere with flight duties:(If unable to pass hearing tests with CI turned off, go to Row B.)	ISSUEAnnotate this information in Block 60 AND List the age the CI was placed and reason. Specify if they passed the hearing test with the CI turned on or off.This does NOT require a hearing limitation or MFT.
B. Implant was placed for hearing loss as a child/teenNote: Pilots with a CI should fly with a spare processor and extra batteries.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating Ear, Nose, & Throat (ENT) or audiologist no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis);• Prognosis; and follow-up.2. The Clinical Progress Note must specifically include:• Reason for the implant;• Date of implant;• How the individual functions with the device;• Ability to hear in noisy environment; and• Word discrimination3. Audiogram performed no more than 90 days prior to the AME exam.	DEFER Submit the information to the FAA for a possible Special Issuance.Even if they pass the hearing test in the AME office.Annotate elements or findings inBlock 60.

Note: If pilot is unable to pass MFT or known to be deaf, see Item 49. Hearing.

• ACOUSTIC NEUROMA
• All Classes
• (Updated 05/30/2018)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Treated 5 or more years ago With• Surgery OR• Stereotactic radiation	The AME should review a current status report from the treating physician. If no symptoms or current problems, no ongoing treatment or surveillance needed:	ISSUE Summarize history in Block 60.Submit documents to the FAA for retention in the file.
B. Treated 5 or more years ago With• Observation ONLY	Submit the following to the FAA for review: ☐ Current status report from the treating physician with treatment plan and prognosis; o It should identify all treatment used, size of the tumor at diagnosis, and current size; ☐ List of medications and side effects, if any; ☐ Operative notes and discharge summary, if applicable; and ☐ Copies of most recent imaging report(s) (MRI).	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.
C. Treated less than 5 years ago With ANY of the following:• Observation,• Surgery, OR• Stereotactic radiation	Submit the following to the FAA for review: ☐ Current status report from the treating physician (ENT or neurosurgeon) with o Treatment plan, prognosis, and adherence to treatment; o It should indicate the presence or absence of any residual tumor and any complications; ☐ List of medications and side effects, if any; ☐ Operative notes and discharge summary (if applicable); SEE NEXT PAGE ☐ Copies of initial and most recent imaging reports (MRI) and lab; ☐ Current audiogram (pure tone and speech discrimination); and ☐ If any neurologic deficit is noted, current documentation of the deficit and severity, as well as the status of the rest of the neurologic exam by treating neurosurgeon or neurotologist, must be submitted.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.

• INNER EAR:
• ACUTE OR CHRONIC DISEASE
• All Classes
• (Updated 11/29/2023)

• BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)
• All Classes
• (Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. RESOLVEDAND symptoms lasted 1 year or less in total.(This may have been single or multiple episode[s]).	If the AME can determine:• The condition has fully resolved without sequelae (with favorable notes from PCP, ER, or ENT);• No symptoms or current problems that would interfere with flight duties;• Medications, if any, are discontinued; and• No hearing loss:Note: Symptoms should be brief, mild, not disabling, and respond to repositioning.	ISSUEAnnotate this information in Block 60.
B. Multiple/intermittent episodes for which the combined time of symptoms/sickness lasted 1 year or more.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or PCP no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis);• Follow-up; and• It must specifically include any underling pathology, if found.2. Copies of additional tests such as (ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.) performed as clinically indicated.	DEFERSubmit the information to the FAA for a possible Special Issuance.Annotate elements or findings inBlock 60.
C. Severe/persistent recurrent/refractory to treatmentORRequiring surgery at any time	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ENT, preferably with a neurotologist (a subspecialty of ENT/otolaryngology). The clinic visit should be no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up.2. If surgery was performed, copies of all clinic records including:• Operative notes;• Hospital admission H&P;• Discharge summary; and• Copies of any testing performed including CT/MRI/imaging.	DEFERSubmit the information to the FAA for a possible Special Issuance.

LABYRINTHITIS

(Vestibular Neuritis, Viral Labyrinthitis, Epidemic Vertigo, Acute Vestibulopathy)

All Classes

(Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Single episode now completely resolved	If the AME can determine:• The condition has fully resolved without sequelae (with favorable notes from PCP or ENT if recent event);• No symptoms or current problems that would interfere with flight duties;• No medication needed; and• No hearing lossNote: This condition usually takes approximately one month before fully recovered.	ISSUEAnnotate this information in Block 60.
B. Current symptoms	The AME should not issue if there are current symptoms.Both the condition and medication to treat are of aeromedical concern.Once resolved, go to Row A.If recurrent symptoms, go to Row C.	DEFER Submit the information to the FAA.Annotate (elements or findings) Block 60.
C. Multiple episodes separated by weeks to months	Submit the following for FAA review:3. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ENT (otolaryngologist), preferably a neurotologist (a sub-specialty of ENT/otolaryngology). The clinic visit should be no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up.2. It must specifically include if:• Any underlying pathology is found• Any hearing loss is noted.	DEFER Submit the information to the FAA for a possible Special Issuance.Annotate (elements or findings) in Block 60.
	3. Treatment notes4. Vestibular testing already performed.5. Current (performed within the past 90 days) clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discrimination (SD).6. Typed personal statement describing the history of the condition. It must include:• If there is any family history;• Episodes of hearing loss over the last year;• The number of episodes with approximates dates and how long each lasted;• A description of the severity of the attacks with type of symptoms;• Any history of Migraine or drop attacks (collapsing suddenly without fainting),• Medication used for control/treatment;• Any surgery;• Success of control (e.g., How often do you have a recurrence? When was most recent episode?); and• Therapy/medication used for control.If any underlying condition is found, see that page.

• MENIERE’S DISEASE
• All Classes
• (Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Previously reviewed and warned by the FAA.	If the AME can determine there have been no further symptoms or episodes of vertigo:Note: The medical certificate should not be issued for any class until condition is fully resolved and reviewed by the FAA.Pilot duties must be discontinued while symptomatic or on medication for vertigo.	ISSUEIf continued asymptomatic, annotate this information in Block 60.If return of symptoms, DEFER and submit the most recent ENT evaluation.
B. The FIRST time the condition is reported to the FAA.	After a recovery period of six (6) months showing:• Control of vertigo;• No further vertiginous attacks: AND• Hearing remains within standards.Submit the following for FAA review:1. Current (performed within the past 90 days), detailed clinical otolaryngologist (ENT) evaluation and progress note that documents sustained control and no recurrence of symptoms. It must address if active disease exists. If in remission, when did remission commence.2. Current (performed within the past 90 days) clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discrimination (SD).3. Typed personal statement describing the history of the condition. It must include:• If there is any family history;• If single side or bilateral;• Episodes of hearing loss over the last year;• The number of attacks;• A description of the severity of the attacks with type of symptoms;• Any history of migraine or drop attacks (collapsing suddenly without fainting);	DEFERSubmit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the Authorization Letter
	• Medication used for control/treatment given;• Any surgery;• Success of control (e.g., How often do you have a recurrence? When was most recent episode?); and• Therapy/medication used for control.4. Additional tests such as (ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.) performed as clinically indicated.5. All treatment records associated with diagnosis.Note: Pilot and safety related duties (SRD) duties must be discontinued while on medication for vertigo. 14 CFR 61.53 applies.Medication: Betahistine (Serc, Beta-Serc) is NOT allowed.
C. With associated hearing loss.	If there is associated hearing loss, the individual should be evaluated to determine if they meet hearing standards.See Item 49. Hearing.	DEFERSubmit the information to the FAA

• MOTION SICKNESS
• All Classes
• (Updated 11/29/2023)

• PERILYMPH FISTULA (PLF)
• All Classes
• (Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Resolved 5 or more years ago.	The AME should review the most recent detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist.If it verifies the treatment has been completed (surgical or medical) and no further episodes:	ISSUEAnnotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
B. FIRST time the condition is reported to the FAAORA new episode Within the last 5 years.	Once resolved and recovery period of:• One (1) month after surgery; or• Three (3) months if treated medically or with observation; and• Showing no further vertiginous attacks and hearing remains within standards.Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days prior to the AME exam.2. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan prognosis; and• Follow-up.3. It must specifically include:• If active disease exists.• If in remission, when did remission commence.4. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discriminati on (SD) (performed within the past 90 days).	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the Authorization Letter
	5. Additional tests such as (ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.) performed as clinically indicated.6. All Office treatment records.7. Copy of Operative report if surgery performed.8. Personal statement (typed) stating:• Number of attacks;• Severity;• Type of symptoms;• Episodes of hearing loss over the last year;• What type of therapy or medication(s) are used for control; and• How did the episode occur? (e.g., childbirth, straining, weightlifting, lightning strike, etc.).

• PERSISTENT POSTURAL PERCEPTUAL DIZZINESS (PPPD OR 3PD)
• All Classes
• (Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Any history	• After the condition has fully resolved;• No symptoms remain; and• Medication is no longer needed for suppression of the vertigo:Submit the following for FAA review:3. A current, detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up4. It must specifically include:• If active disease exists.• If in remission, when did remission commence.5. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discriminat ion (SD) (performed within the past 90 days).6. Additional tests such as [ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle (CPA), etc.] performed as clinically indicated.7. All Office treatment records.8. Pharmacy Records for the last 3 years from all Pharmacies used.9. Copies of any Vestibular Rehab progress notes (if performed).	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the Authorization Letter

• SUPERIOR SEMICIRCULAR CANAL DEHISCENCE SYNDROME (SSCDS)
• All Classes
• (Updated 11/29/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Incidental finding on imagingANDNO symptoms	The AME should obtain why the imaging was performed.Review a detailed, Clinical Progress Note from ENT (otolaryngology) performed any time after identification on imaging. If the ENT evaluation verifies:• An incidental finding on imaging;• The individual never had symptoms*; and• No required treatmentANDThe AME verifies no symptoms since diagnosis and there is no other condition found (which warranted imaging):If ANY symptoms, go to Row B.*Symptoms may include vertigo induced by a loud noise, autophonia, chronic imbalance, tinnitus, and hyperacusis.If another condition is found, see that page.	ISSUEAnnotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
B. History of symptoms	After:• One (1) month after surgery; and• Released to full duties by the treating physician; and• No further vertiginous attacks; and• Hearing remains within standards.Submit the following for FAA review:10. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ENT (otolaryngologist), preferably a neurotologist (a sub-specialty of ENT/otolaryngology). The clinic visit should be no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the Authorization Letter
	• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up.11. It must specifically include:• If active disease exists.• If in remission, when did remission commence.12. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discrimination (SD) (performed within the past 90 days).13. Additional tests such as (ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.) performed as clinically indicated.14. All Office treatment records.15. Copy of Operative report (if surgery performed).

MASTOIDS

All Classes

MIDDLE EAR ABNORMALITIES

(Otitis Media, Serous Otitis Media, Eardrum Abnormalities, Tympanic Membrane Perforation, Myringotomy, Ear Tubes, PE Tubes, Eustachian Tube Dysfunction)

All Classes

(Updated 01/31/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Myringotomy, Ear tubes, Tympanostomy tubes, Pressure equalizing tubes (PE tubes)(single or bilateral)No matter how many sets	If the AME can determine the condition is under control and no symptoms that would interfere with flight or safety-related duties:Note: There is no mandatory recovery period after PE tubes are placed other than wait time for General anesthesia (if used).	ISSUEAnnotate this information in Block 60
B. RESOLVED Otitis media/ ear infectionTympanic membrane perforation (dry)ORSerous Otitis Media	If the AME can determine the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight dutiesANDThe individual can pass any of the acceptable hearing tests:	ISSUEAnnotate this information in Block 60
C. ALL OTHERSActive acute Otitis Media/ear infectionChronic Otitis MediaChronic tympanic membrane perforationEustachian Tube Dysfunction (ETD)Recurrent Acute Otitis MediaWet tympanic membrane perforationAny of the above with associated pathology	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the otolaryngologist (ENT) or PCP no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up.	DEFERSubmit the information to the FAA for a possible Special Issuance

• OUTER EAR ABNORMALITIES
• (Cerumen Impaction, Otitis Externa, Microtia)
• All Classes
• (Updated 01/31/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Impacted cerumen not affecting hearingOROtitis Externa (resolved) or not affect flying/safety-related duties	If the AME can determine the condition has no symptoms or current problems that would interfere with flight dutiesANDThe individual can pass any of the acceptable hearing tests:	ISSUEAnnotate this information in Block 60.
B. With complicationsORIncapacitatingORAffecting hearing (Unable to pass any of the acceptable hearing tests or the AME has concerns)	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ear, nose, and throat (ENT) physician no more than 90 days before the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan (prognosis); and• Follow-up. 2. All audiograms already performed.	DEFER Submit the information to the FAA for a possible Special Issuance.
C. Outer ear/external pinna abnormality (such as Microtia)	The AME should look closely at the affected ear for other visible signs of pathology such as pre auricular pits or brachial cleft cyst or other evidence of a syndromic nature.If the AME can determine the condition has no symptoms or current problems that would interfere with flight dutiesANDThe individual can pass any of the acceptable hearing tests:	ISSUEAnnotate this information in Block 60.Note: If the applicant is unable to pass any of the acceptable hearing tests or the AME has concerns, the AME should annotate this in Block 60 and DEFER.

ITEM 30. Ear Drums EAR DRUMS

All Classes

Otologic Surgery: A history of otologic surgery is not necessarily disqualifying for medical certification. The FAA evaluates each case on an individual basis following review of the otologist's report of surgery. The type of prosthesis used, the person's adaptability and progress following surgery, and the extent of hearing acuity attained are all major factors to be considered. AME should defer issuance to an applicant presenting a history of otologic surgery for the first time, sending the completed report of medical examination, with all available supplementary information, to the AMCD.

Some conditions may have several possible causes or exhibit multiple symptomatology. Episodic disorders of dizziness or disequilibrium require careful evaluation and consideration by the FAA. Transient processes, such as those associated with acute labyrinthitis, or benign positional vertigo may not disqualify an applicant when fully recovered. (Also see Item 46., Neurologic for a discussion of syncope and vertigo).