Ear, Nose, and Throat Disorders

USAF Waiver Guidelines 

Notes that BPPV is waiverable for class II and III flying duties, Air Traffic Controller/Ground Based Controller, and Mobile Ordinance Disrupters duties. It is not waiverable for class I/IA flying duties.

The guidelines stress having an accurate diagnosis, as do the guidelines above, as prognosis for recurrence and incapacitation are dependent on diagnosis. BPPV is noted to have short-duration episodes, usually less than 30 seconds, that are
typically brought on by predictable head movements or positions. This, of course, would cause less risk of sudden incapacitation.

“The symptoms of BPPV pose a definite risk of incapacitation, which may jeopardize flying safety, although the brief duration of symptoms (less than 20-30 seconds) and the fact that symptoms are provoked by only very specific head maneuvers may permit recovery from an in-flight occurrence and safe return if such provocative maneuvers can be avoided. BPPV may therefore pose more risk to mission completion than to flying safety, unless symptoms occur during particularly critical phases of flight. Therefore, waivers are usually only recommended for multi-crew aircraft.”

BPPV is stated to account for about 50% of cases of peripheral vertigo. Lifetime prevalence is cited at 2.4%, with recurrence rates of 15-18% in the first year, and up to 50% within 5 years. Response to CRP is reported at 70-95%. It is also
noted that BPPV is self-limited, with spontaneous resolution, though remission can take months.