Otosclerosis and Aeromedical Fitness: Insights from Three Cases and a Literature Review

Abstract

Otosclerosis is a hereditary disorder characterized by abnormal bone remodeling in the otic capsule, leading to progressive conductive hearing impairment. This condition presents significant challenges for pilots and aircrew. The flight environment, with its inherent noise, pressure fluctuations, and acceleration forces, complicates the management of pilots affected by otosclerosis. While fitness waivers can allow some to continue flying with periodic monitoring, progressive hearing loss may require further intervention. This paper presents the cases of three pilots with otosclerosis, followed at the Center of Aeromedical Expertise at the Mohamed V Military Training Hospital, each facing different aeromedical challenges. Cases Presentation: • Case 1: A commercial airline captain with bilateral hearing impairment who successfully underwent a speech comprehension test in a simulator and was certified fit to fly with a waiver. • Case 2: A helicopter pilot in the armed forces with unilateral otosclerosis, who underwent flight testing in noisy conditions and was granted a restricted flight fitness waiver. • Case 3: A fighter pilot with severe otosclerosis who underwent a successful stapedotomy, restoring hearing function and receiving fitness approval with close medical supervision. Policy reform is needed for aeromedical certification of patients with otosclerosis. While stapes surgery improves hearing, barotrauma and perilymphatic fistula have disqualified pilots from flying. Existing research shows that with comprehensive vestibulocochlear testing - such as audiometric monitoring and in-flight testing - pilots can be cleared to return to duty. Individualized aeromedical evaluations are required to balance flight safety and career continuity for pilots with this condition.