Pilots – often understandably – like to debate the wisdom of the FAA’s medical certification policies. Whether considering well-controlled chronic conditions like high blood pressure and diabetes, or long-resolved mental health issues like childhood ADHD and brief bouts of depression, that can be understandable.
Most people accept the danger posed by extreme cases, but the risk to aviation safety can be hard to grasp when the symptoms of a condition do not affect you on a day-to-day basis. However, no one seems to question whether or not vertigo-prone pilots should step into the flight deck.
In my experience, pilots tend to treat this condition even more conservatively than the FAA. That probably has something to do with the fact that just about every seasoned aviator has experienced “the leans” or some other form of spatial disorientation at least once. The experience is scary and potentially deadly.
By some estimates, spatial disorientation was a causal factor in one-third of all aviation mishaps and almost always resulted in fatality [1]. While vertigo only accounts for a portion of spatial disorientation episodes [2], it is among the most frightening.
Disorientation that involves the inner ear often goes unrecognized by pilots which makes it difficult to correct and, in turn, to survive.
Vertigo is just a symptom – the FAA cares about the disease
As dangerous as it can be, all vertigo is not the same. Often described by those afflicted as “dizziness”, the term “vertigo” simply describes a sensation of moving or spinning that is different from the moving or spinning that is taking place.
Moreover, much like chest pain can be caused by a wide range of conditions from indigestion to coronary artery disease, vertigo symptoms can happen for many reasons.
Some of them are relatively benign and self-limited like viral respiratory infections. Others, like Meniere’s disease and tumors, can have long-term consequences for your health and quality of life, much less your flying career.
When it comes to your FAA medical certificate, several questions need to be considered [3]:
- What caused it?
- How long did it last?; and
- How bad was it?
What caused your vertigo?
For cases of mild transient vertigo like Benign Paroxysmal Positional Vertigo – or BPPV – that responds to treatment without medication or labyrinthitis (aka vestibular neuritis), you can qualify for a medical certificate almost immediately after it resolves.
These temporary causes of vertigo typically last for only a short period and do not impart a significant risk of unpredictable recurrence.
On the other hand, Meniere’s disease is a chronic medical condition that tends to progress over time and is associated with life-long problems with balance and hearing.
Similarly, vestibular neuromas are tumors that, if not treated definitively, will not spontaneously improve and will most likely progress over time.
As you can see from just these few examples, the underlying condition that causes vertigo makes a big difference in determining whether or not you can safely return to flying.
How long did it last?
Imagine that you had an upper respiratory tract infection, had trouble with your ear for a week or so, felt like the room was spinning during the worst of it, and had some minor balance issues that lasted for about a month afterward.
It probably wouldn’t be fun. The FAA will be interested, but once you fully recover, you can return to flying.
Now imagine that for more than a year you’ve been back and forth to the emergency room with symptoms so bad you couldn’t see or walk straight.
You’ve been left with permanent hearing loss and your doctors are telling you that, while the last few months have been a welcome reprieve, you’re likely to experience more and worse symptoms in the future.
This other extreme will keep you out of the cockpit for a longer time.
When it comes to your FAA medical certificate, one year of symptoms is an important dividing line. Even if you have multiple episodes, transient causes of vertigo that resolve after less than one year should not affect your FAA medical.
Even if they’ve completely resolved, if your vertigo episodes occurred over more than 12 months, you’ll need to provide a significant amount of documentation before you can qualify for a medical certificate.
How bad was it?
Not all vertigo is created equal. Did you stumble a few times during a cold or were you in bed for days because you could not stand and required multiple medications to control your nausea?
Your AME and, potentially, the FAA will carefully consider where you fall on that spectrum before they decide on your medical certification.
Telling your AME and the FAA about your vertigo
This should go without saying, but make sure your symptoms have resolved completely before you schedule your appointment. If you are still having balance issues, you will not qualify for a medical certificate.
After that important first step, you need to disclose it on your MedXPress application and be prepared to discuss it with your AME.
For mild, transient cases of vertigo that stopped after less than 12 months, you may be able to get by by simply discussing what happened with your AME.
However, if you sought medical attention at any point, you can simplify your AME’s job by providing notes from your treating doctor that clearly document your symptoms have resolved and that you are no longer taking any related medications.
If you had more severe symptoms or you struggled with vertigo for more than 12 months, you will be required to provide medical documentation and your AME will be obligated to defer your application to the FAA for further review and consideration.
What documentation will be required depends heavily on what causes your symptoms in the first place and how your doctors evaluated and treated you.
No matter what, if you have experienced any form of vertigo for any period, it is a good idea to speak with an AME who knows their stuff or use one of our free consults to make sure you are prepared correctly for your AME appointment.
Knowing which information you will need to provide before your AME appointment can shorten the time it takes to get your medical certificate by months.
References
[1] R. Gibb, B. Ercoline, and L. Scharff, “Spatial disorientation: decades of pilot fatalities,” Aviat. Space Environ. Med., vol. 82, no. 7, pp. 717–724, Jul. 2011, doi: 10.3357/asem.3048.2011.
[2] R. K. Meeks, J. Anderson, and P. M. Bell, “Physiology Of Spatial Orientation,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2023. Accessed: Dec. 20, 2023. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK518976/
[3] “Guide for Aviation Medical Examiners | Federal Aviation Administration.” Accessed: Dec. 22, 2023. [Online]. Available: https://www.faa.gov/ame_guide/app_process/exam_tech/item29/amd
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