Ear, Nose, and Throat Disorders

Recommendations

Candidates: Verify diagnosis and appropriate treatment (CRP) by review of records and/or physical exam. Candidates with vertigo that cannot be ascribed to BPPV (or resolved vestibular neuronitis) with a high degree of confidence should not be certified. 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. Do not certify if active symptoms or require medications to control symptoms on a regular or frequent basis. Given the risk of recurrence, the candidate should be free from symptoms off medications for 6 months (FMCSA recommends 2 months symptom free off medications prior to certification for commercial driving duties).

Incumbents: For incumbents who experience an episode of BPPV, remove from safety sensitive duties where sudden incapacitation would cause unacceptable risk to the officer or others, until symptoms are resolved off medication for at least 2 months.  Ensure an accurate diagnosis and appropriate treatment as noted above. If attacks are frequent, they require regular or frequent medications to control symptoms, or are unusually severe, consider permanent restrictions from safety sensitive duties.