Chronic sinusitis is a common medical condition among pilots, and one that can directly impact FAA medical certification. The FAA takes sinus conditions seriously because they affect flight safety through issues like barosinusitis, in-flight incapacitation from pain or infection, and impaired oxygenation. For airmen navigating both their health and medical certification, understanding how the FAA evaluates chronic sinusitis is essential.

What is Chronic Sinusitis?

By clinical definition, chronic sinusitis refers to inflammation of the paranasal sinuses that persists for 12 weeks or longer despite medical therapy. Typical symptoms include:

• Facial pressure or pain
• Nasal obstruction or congestion
• Thick nasal discharge
• Reduced or absent sense of smell

Diagnosis often requires objective evidence from sinus CT imaging or nasal endoscopy, as outlined by ENT specialists. Unlike acute sinusitis, which resolves after a short course of treatment, chronic sinusitis reflects a persistent condition that may require long-term medical management or surgical intervention.

FAA Certification Standards

According to the FAA Guide for Aviation Medical Examiners , applicants with sinusitis must be carefully evaluated for any evidence of obstruction, infection, or complications that could interfere with flight duties.

• Acute sinusitis is disqualifying until the infection has resolved.
• Chronic sinusitis requires deferral if symptoms are uncontrolled, if there is frequent recurrence, or if the pilot has required recent sinus surgery.
• Pilots must be asymptomatic, have stable findings, and show no evidence of obstruction or barosinusitis risk before certification is considered.

In many cases, the FAA will request additional documentation such as:

• ENT evaluation notes
• Sinus CT imaging results
• Surgical or treatment records
• A status report confirming symptom control and absence of complications

Risks Considered by the FAA

From a flight safety perspective, sinus disease poses several concerns:

• Barosinusitis: Painful sinus pressure changes during ascent and descent can incapacitate a pilot.
• Recurrent infections: Chronic infections can impair alertness, lead to missed duty time, and indicate underlying obstruction.
• Surgical outcomes: Post-surgical pilots must demonstrate resolution of obstruction and stability before returning to flight status.

Path to Medical Certification

For pilots with a history of chronic sinusitis, the FAA process generally includes:

1. Treatment and stabilization: Completing prescribed medical or surgical therapy.
2. ENT clearance: A detailed evaluation showing resolution or control of symptoms.
3. Submission of records: Providing CT scan results, operative notes, and a current ENT status letter to the FAA.
4. Case-by-case decision: The FAA may issue a medical certificate once risks of obstruction, infection, or barosinusitis are mitigated.

Practical Considerations for Pilots

• Do not attempt to fly with acute sinus symptoms. Even mild congestion can cause severe barosinusitis.
• After sinus surgery, wait for full healing and ENT clearance before reapplying.
• Provide complete documentation up front to avoid unnecessary FAA deferral delays.

Bottom Line

Chronic sinusitis does not automatically end a flying career, but it does demand careful documentation and medical stability before FAA certification is granted. The FAA’s primary concern is the risk of in-flight incapacitation. Pilots who work with their ENT physician and provide the FAA with clear, objective evidence of stability usually achieve favorable outcomes.