My Flight Surgeon
Sr. Aviation Medical Examiner
This is one of a series of posts about medical issues potentially affecting a pilot’s ability to obtain a medical certificate. In this series, we will look at common problems seen by the AME, review the requirements the FAA has to consider allowing one to fly and discuss what you need to do to expedite consideration by the FAA to allow you to fly. We plan to go through all of the medical history items in Section 18 on the front of Form 8500-8 over the next several months.
Item18b. Dizziness or fainting spells
Item18b (Dizziness or fainting spells) on the FAA Form 8500-8 (the one you fill out in the AME’s office) asks if there is a history of frequent or severe headaches. If so, the FAA states the applicant should describe characteristics of the episode; e.g., spinning or lightheadedness, frequency, factors leading up to and surrounding the episode, associated neurologic symptoms; e.g., headache, nausea, loss of consciousness, or paresthesias. Include diagnostic workup and treatment if any.
We will take a brief look at some of the conditions evaluated for this portion of the history. This is not an all inclusive list but covers most of the important diseases considered by the AME when you answer Item 18b Yes.
1) Loss of bony substance involving the two tables of the cranial vault. The issue here is the underlying condition that resulted in loss of bones of the skull.
2) Evidence of severe allergic rhinitis, Obstruction of sinus ostia, including polyps, that would be likely to result in complete obstruction. These conditions can cause obstruction of the opening to the sinuses or middle ear causing pain, dizziness and even incapacitating vertigo. These problems become more severe with decent after being at altitude (even pressurized cabin altitude).
3) Sinusitis, with the intermittent use of topical or non-sedating medication. If this responds to treatment without any side effects, a medical certificate may be issued by the AME. If it is severe-requiring continuous use of medication or effected by barometric changes. This requires review by the FAA and a Special Issuance.
4) Polyps and cysts of the sinuses. If these are non-cancerous, have not grown in 12 months and are not in a position to block the sinus opening, the AME may issue the certificate. Obviously, to make this decision, the AME will need information such as a report from an ENT doctor or a CT scan of the sinuses. If the polyp is malignant (cancerous), issuance requires an FAA decision.
5) Conditions of the ear. This includes acoustic neuroma, a tumor of the 8th cranial nerve, which causes dizziness. Acoustic neuroma requires an FAA decision regarding the medical certificate. Acute or chronic disease without disturbance of equilibrium and successful miringotomy, if applicable are conditions in which the AME may issue the medical certificate with the appropriate medical information. On the other hand, acute or chronic disease that may disturb equilibrium require review by the FAA before a medical certificate is issued. Motion Sickness is a problem we see often. If it requires medication for control, it will require FAA review for issuance of the medical certificate. If it occurred during flight training and resolved then the AME may issue the certificate. Diseases of the mastoid bone require FAA approval for issuance. Chronic infection of the middle ear (otitis media) requires an approval from the FAA for a medical certificate.
6) Numerous conditions may affect equilibrium, resulting in acute incapacitation or varying degrees of chronic recurring spatial disorientation. Prophylactic use of medications also may cause recurring spatial disorientation and affect pilot performance. In most instances, further neurological evaluation will be required to determine eligibility for medical certification. Neurologic conditions that may cause dizziness include: Alternobaric Vertigo, Hyperventilation Syndrome, Meniere's Disease and Acute Peripheral Vestibulopaty, Nonfunctioning Labyrinths, and Orthostatic Hypotension and all require an FAA decision regarding medical certification.
7) Other neurologic conditions which may affect consciousness. These all require an FAA decision regarding the issuance of a medical certificate and they include: A disturbance of consciousness without satisfactory medical explanation of the cause, Epilepsy,and Transient loss of nervous system function(s) without satisfactory medical explanation of the cause; e.g., transient global amnesia. If there is a history of febrile seizures that occurred prior to age 5, without recurrence and off medications for 3 years the AME may issue the certificate.
The important take home points regarding dizziness and fainting include: 1) if you are having problems clearing your ears or develop sinus pressure on decent you should have this evaluated to insure it does not become disqualifying; 2) there are conditions which can cause incapacitating vertigo and if not addressed these will kill you; and 3) there are conditions (such as epilepsy) which are just flat outright dangerous when you are a pilot.
*Italicized sections are excerpts from FAA documents.
Item18b. Dizziness or fainting spells
Dizziness or fainting spells
Like headaches, dizziness is a common problem seen in physicians’ offices. On the other hand, fainting spells are relatively uncommon. From the FAA’s perspective, both of these symptoms may be a sign of severe underlying disease of the ears, sinuses, nose, mouth and throat or neurologic system. The FAA wants to know that the symptoms are from mild, transient problems and not diseases as severe as multiple sclerosis or a tumor of the pharynx.Item18b (Dizziness or fainting spells) on the FAA Form 8500-8 (the one you fill out in the AME’s office) asks if there is a history of frequent or severe headaches. If so, the FAA states the applicant should describe characteristics of the episode; e.g., spinning or lightheadedness, frequency, factors leading up to and surrounding the episode, associated neurologic symptoms; e.g., headache, nausea, loss of consciousness, or paresthesias. Include diagnostic workup and treatment if any.
We will take a brief look at some of the conditions evaluated for this portion of the history. This is not an all inclusive list but covers most of the important diseases considered by the AME when you answer Item 18b Yes.
1) Loss of bony substance involving the two tables of the cranial vault. The issue here is the underlying condition that resulted in loss of bones of the skull.
2) Evidence of severe allergic rhinitis, Obstruction of sinus ostia, including polyps, that would be likely to result in complete obstruction. These conditions can cause obstruction of the opening to the sinuses or middle ear causing pain, dizziness and even incapacitating vertigo. These problems become more severe with decent after being at altitude (even pressurized cabin altitude).
3) Sinusitis, with the intermittent use of topical or non-sedating medication. If this responds to treatment without any side effects, a medical certificate may be issued by the AME. If it is severe-requiring continuous use of medication or effected by barometric changes. This requires review by the FAA and a Special Issuance.
4) Polyps and cysts of the sinuses. If these are non-cancerous, have not grown in 12 months and are not in a position to block the sinus opening, the AME may issue the certificate. Obviously, to make this decision, the AME will need information such as a report from an ENT doctor or a CT scan of the sinuses. If the polyp is malignant (cancerous), issuance requires an FAA decision.
5) Conditions of the ear. This includes acoustic neuroma, a tumor of the 8th cranial nerve, which causes dizziness. Acoustic neuroma requires an FAA decision regarding the medical certificate. Acute or chronic disease without disturbance of equilibrium and successful miringotomy, if applicable are conditions in which the AME may issue the medical certificate with the appropriate medical information. On the other hand, acute or chronic disease that may disturb equilibrium require review by the FAA before a medical certificate is issued. Motion Sickness is a problem we see often. If it requires medication for control, it will require FAA review for issuance of the medical certificate. If it occurred during flight training and resolved then the AME may issue the certificate. Diseases of the mastoid bone require FAA approval for issuance. Chronic infection of the middle ear (otitis media) requires an approval from the FAA for a medical certificate.
6) Numerous conditions may affect equilibrium, resulting in acute incapacitation or varying degrees of chronic recurring spatial disorientation. Prophylactic use of medications also may cause recurring spatial disorientation and affect pilot performance. In most instances, further neurological evaluation will be required to determine eligibility for medical certification. Neurologic conditions that may cause dizziness include: Alternobaric Vertigo, Hyperventilation Syndrome, Meniere's Disease and Acute Peripheral Vestibulopaty, Nonfunctioning Labyrinths, and Orthostatic Hypotension and all require an FAA decision regarding medical certification.
7) Other neurologic conditions which may affect consciousness. These all require an FAA decision regarding the issuance of a medical certificate and they include: A disturbance of consciousness without satisfactory medical explanation of the cause, Epilepsy,and Transient loss of nervous system function(s) without satisfactory medical explanation of the cause; e.g., transient global amnesia. If there is a history of febrile seizures that occurred prior to age 5, without recurrence and off medications for 3 years the AME may issue the certificate.
The important take home points regarding dizziness and fainting include: 1) if you are having problems clearing your ears or develop sinus pressure on decent you should have this evaluated to insure it does not become disqualifying; 2) there are conditions which can cause incapacitating vertigo and if not addressed these will kill you; and 3) there are conditions (such as epilepsy) which are just flat outright dangerous when you are a pilot.
*Italicized sections are excerpts from FAA documents.
