Ear, Nose, and Throat Disorders

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The Hearing Standards

Otological conditions which may result in disqualification include, but are not limited to, the following examples:

  1. Ménière’s disease
  2. Vestibular neuronitis
  3. Vertigo and paroxysmal positional vertigo

Any other disease or defect of the ear that adversely affects hearing or equilibrium, and which potentially interferes with the safe and efficient job performance, is generally disqualifying.

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Otolaryngology-Head and Neck Surgery.2017;156(3S):S1-S47.

Verification of diagnosis (Key Action Statements 1a. Diagnosis of posterior semicircular canal BPPV, and 1b. Diagnosis of lateral (horizontal) semicircular canal BPPV. Posterior semicircular canal (PSC) BPPV accounts for the majority of cases of BPPV. Lateral semicircular canal (LSC) BPPV accounts for 5-22% of cases, while anterior semicircular canal (ASC) BPPV accounts for only 1-3% of cases. BPPV
can be diagnosed reliably by history and physical exam. Accuracy of diagnosis is important in reducing the inappropriate use of additional testing and in ensuring proper treatment.

PSC BPPV is diagnosed by an appropriate history and a positive Dix-Hallpike maneuver.

LSC BPPV is diagnosed by an appropriate history and a positive supine roll test maneuver.

Diagnosis for posterior semicircular canal BPPV is based on: 1) a history of vertigo provoked by changes in head position relative to gravity; and 2) characteristic nystagmus (torsional/upbeating) on the Dix-Hallpike maneuver, with a latency period between the completion of the maneuver and onset of nystagmus, and the nystagmus increases and then resolves within 60 seconds. Diagnosis for lateral (or horizontal) semicircular canal BPPV consists of 1) a history of vertigo provoked by changes in head position relative to gravity, and 2) horizontal or absent nystagmus on the Dix-Hallpike maneuver, and characteristic lateral nystagmus on the supine roll test. Both types of BPPV can be successfully treated by canalith repositioning procedures (CRP), though different procedures are used for each type. This underscores the need for accurate diagnosis. A 2010 meta-analysis showed a 6.5 O.R. for improvement, and a 5.19 O.R. for conversion to a negative Dix-Hallpike maneuver following CRP.

While treatment is effective, recurrence rates are relatively high. While there are only a few quality studies with longer term follow-up, the BPPV recurrence rate is reported to be in the 5-13.5% range at 6 months, and 10-18% at one year. The rate of recurrence is reported to increase with time and may be as high as 36%. Individuals with trauma induced BPPV appear to be at a somewhat higher risk of recurrence.

In general, routine use of antihistamines and/or benzodiazepines is discouraged. Studies have not shown a significant effect on shortening duration of BPPV symptoms, and were inferior in this regard to CPR. However, their use can be considered for symptomatic relief of nausea and vomiting, in a severely symptomatic individual. Given the potential side effects of these medications, this is a significant consideration in LEOs.