PILOT PROTECTION SERVICES NOVEMBER MEDICAL MAILBAG

QUESTION: I have been diagnosed with otosclerosis, which can apparently usually be corrected with a surgical procedure called a stapedectomy. I am told the success rate is quite high and we have found an experienced surgeon who we trust. However, he has little experience with patients who are also pilots and can offer no firsthand advice as to how this may affect flying.

I am an agricultural pilot and also do aerobatics so I do have a concern about positive and negative G forces, as well as pressure changes and how that may affect the prosthetic device that is implanted during the surgery. Can you please provide some information as to how this will impact my flying?

ANSWER: Otosclerosis literally means the formation of new bone inside the ear and although it most commonly affects young women, when it is often instigated by pregnancy, anyone can be affected. Inside the middle ear three bones, the malleus (hammer), incus (anvil), and stapes (stirrup), transmit vibrations of the ear drum (tympanic membrane) in a process that leads to the perception of hearing. In otosclerosis the new bone growth impedes the movement of these bones, thereby causing hearing loss. Vertigo (a spinning sensation) and tinnitus (ringing in the ears) are uncommon. Therefore, unless vertigo was present before surgery, it should not be an issue afterward, so G-loads and pressure changes should not cause concern.
The common operative procedure is a stapedectomy to remove the immobile stapes bone. One then covers the membrane with a piece of tissue to achieve healing and then a prosthesis that looks like a bucket handle with a prong that sits in a footplate and fulfills the function of the removed bone.

From FAA’s perspective, stapedectomy is no big deal. They will want to see a report from the surgeon, but if the airman meets hearing standards (hears conversational voice at six feet with back turned to examiner) he should be fine. 

QUESTION: I have been dealing with the FAA for five months now trying to get my medical certificate cleared. It is a profoundly frustrating experience because of the gross inefficiency of the medical review process. My biggest complaint is it takes so long to hear from them after they get the information they requested. It took almost three months just to get a letter back from them, asking for yet more information. Why didn’t they ask for everything at the same time? Even though I don’t currently have a condition that will take me out of the airplane, I may develop one by the time the FAA finally gets around to issuing my medical! What is with this bureaucracy, anyway?

ANSWER: Your frustration is shared by just about anyone who deals with the FAA’s Aerospace Medical Certification Division. Trying to explain all the complexities of the medical certification review process is far beyond the bandwidth we have available here. However, the short answer is that the FAA has the responsibility of the national airspace safety directly in their crosshairs, and the Agency takes that responsibility seriously. Unfortunately, with the number of certificated pilots in the US, the complexity of the medical certification process, and the scarcity of resources to improve the process, the net result is long delays. There are some tips that can help to minimize the delays, but even if you do everything correctly, the FAA’s workload can still produce frustrating wait times before you hear from them. 

QUESTION: I had an atrial septal defect repaired when I was in my early teens. I’m applying for my first medical certificate and see that I need to report hospitalizations anytime in my life. Will I need any medical records to provide to the FAA?

ANSWER: Generally, the first time a condition is reported on a medical application, the FAA will want to see the records, if they are still available. If the condition is a “remote” history, that is, it happened a long time ago, and there have been no more recent symptoms or treatment, the historical records will probably be enough for the aviation medical examiner (AME) to issue your medical certificate at the time of examination. At the other extreme, the FAA could ask for a current cardiovascular evaluation that might include a treadmill stress test and/or an echocardiogram, and a current status report from the treating physician. As a rule, anytime you’re reporting something to the FAA the first time, have records with you to help the medical examiner determine if your medical can be issued on the spot.