Middle ear problems
What the FAA's documents say about middle ear problems, in plain words, with the FAA's own words one press away.
FAA term: Middle Ear Abnormalities (Otitis Media; Serous Otitis Media; Eardrum Abnormalities; Tympanic Membrane Perforation; Myringotomy; Ear Tubes; PE Tubes; Eustachian Tube Dysfunction)Covers: All classes
Show the FAA's words: which classes the FAA's table covers
MIDDLE EAR ABNORMALITIES (Otitis Media; Serous Otitis Media; Eardrum Abnormalities; Tympanic Membrane Perforation; Myringotomy; Ear Tubes; PE Tubes; Eustachian Tube Dysfunction) All Classes
Short version
The disposition table has three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AMyringotomy or ear tubes, single or bilateral | Examiner issues | Examiner can issue |
| Row BResolved otitis media, dry perforation, or serous otitis media | Examiner issues | Examiner can issue |
| Row CAll others, as the row lists them | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Middle ear problems
- Row A · Examiner can issue
Myringotomy, ear tubes, tympanostomy tubes or pressure equalizing tubes (PE tubes), single or bilateral, no matter how many sets. If the examiner can determine the condition is under control and there are no symptoms that would interfere with flight or safety-related duties, the table says ISSUE, and the examiner annotates this information in Block 60. The row's note says there is no mandatory recovery period after PE tubes are placed other than wait time for general anesthesia (if used).
A. Myringotomy, Ear tubes, Tympanostomy tubes, Pressure equalizing tubes (PE tubes) (single or bilateral) No matter how many sets If the AME can determine the condition is under control and no symptoms that would interfere with flight or safety-related duties: Note: There is no mandatory recovery period after PE tubes are placed other than wait time for General anesthesia (if used). ISSUE Annotate this information in Block 60
- Row B · Examiner can issue
Under the heading RESOLVED, otitis media or ear infection, tympanic membrane perforation (dry), or serous otitis media. If the examiner can determine "the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties" (the table's words) and the individual can pass any of the acceptable hearing tests, the table says ISSUE, and the examiner annotates this information in Block 60.
B. RESOLVED Otitis media/ ear infection Tympanic membrane perforation (dry) OR Serous Otitis Media If the AME can determine the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties AND The individual can pass any of the acceptable hearing tests: ISSUE Annotate this information in Block 60
- Row C · Special Issuance
All others, which the row lists as active acute otitis media or ear infection, chronic otitis media, chronic tympanic membrane perforation, Eustachian tube dysfunction (ETD), recurrent acute otitis media, wet tympanic membrane perforation, and any of the above with associated pathology. The table lists what to submit for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
C. ALL OTHERS Active acute Otitis Media/ear infection Chronic Otitis Media Chronic tympanic membrane perforation Eustachian Tube Dysfunction (ETD) Recurrent Acute Otitis Media Wet tympanic membrane perforation Any of the above with associated pathology Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
The FAA pathways for middle ear problems
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: Row A: what the examiner determines
Myringotomy or ear tubes, single or bilateral, no matter how many sets.For Row A, your AME determines the findings the row lists. If your AME can determine them, the table says ISSUE.
If the AME can determine
- The condition is under control
- No symptoms that would interfere with flight or safety-related duties
At the exam
- Your AME annotates this information in Block 60
Show the FAA's words: Row A: what the examiner determines
If the AME can determine the condition is under control and no symptoms that would interfere with flight or safety-related duties:
ISSUE
FAA source: Middle Ear. FAA date 31 January 2024; checked by Crosscheck 14 October 2026.
ISSUE Annotate this information in Block 60
FAA source: Middle Ear. FAA date 31 January 2024; checked by Crosscheck 14 October 2026.
Note: There is no mandatory recovery period after PE tubes are placed other than wait time for General anesthesia (if used).
FAA source: Middle Ear. FAA date 31 January 2024; checked by Crosscheck 14 October 2026.
Step 2: See your AME
If the examiner can determine the condition is under control and there are no symptoms that would interfere with flight or safety-related duties, the table says ISSUE, and the examiner annotates this information in Block 60. The row's note says there is no mandatory recovery period after PE tubes are placed other than wait time for general anesthesia (if used).Exam day- If the examiner can determine the condition is under control and there are no symptoms that would interfere with flight or safety-related duties, the table says ISSUE, and the examiner annotates this information in Block 60. The row's note says there is no mandatory recovery period after PE tubes are placed other than wait time for general anesthesia (if used).
Show the FAA's words: See your AME
A. Myringotomy, Ear tubes, Tympanostomy tubes, Pressure equalizing tubes (PE tubes) (single or bilateral) No matter how many sets If the AME can determine the condition is under control and no symptoms that would interfere with flight or safety-related duties: Note: There is no mandatory recovery period after PE tubes are placed other than wait time for General anesthesia (if used). ISSUE Annotate this information in Block 60
FAA source: Middle Ear. FAA date 31 January 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
If the examiner can determine the condition is under control and there are no symptoms that would interfere with flight or safety-related duties, the table says ISSUE, and the examiner annotates this information in Block 60. The row's note says there is no mandatory recovery period after PE tubes are placed other than wait time for general anesthesia (if used).
Row BExaminer issuesExaminer can issue
If the examiner can determine "the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties" (the table's words) and the individual can pass any of the acceptable hearing tests, the table says ISSUE, and the examiner annotates this information in Block 60.
Row CDefers to the FAASpecial Issuance
The table lists what to submit for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Myringotomy, ear tubes, tympanostomy tubes or pressure equalizing tubes (PE tubes), single or bilateral, no matter how many sets. If the examiner can determine the condition is under control and there are no symptoms that would interfere with flight or safety-related duties, the table says ISSUE, and the examiner annotates this information in Block 60. The row's note says there is no mandatory recovery period after PE tubes are placed other than wait time for general anesthesia (if used).
A. Myringotomy, Ear tubes, Tympanostomy tubes, Pressure equalizing tubes (PE tubes) (single or bilateral) No matter how many sets If the AME can determine the condition is under control and no symptoms that would interfere with flight or safety-related duties: Note: There is no mandatory recovery period after PE tubes are placed other than wait time for General anesthesia (if used). ISSUE Annotate this information in Block 60
- Row B · Examiner can issue
Under the heading RESOLVED, otitis media or ear infection, tympanic membrane perforation (dry), or serous otitis media. If the examiner can determine "the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties" (the table's words) and the individual can pass any of the acceptable hearing tests, the table says ISSUE, and the examiner annotates this information in Block 60.
B. RESOLVED Otitis media/ ear infection Tympanic membrane perforation (dry) OR Serous Otitis Media If the AME can determine the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties AND The individual can pass any of the acceptable hearing tests: ISSUE Annotate this information in Block 60
- Row C · Special Issuance
All others, which the row lists as active acute otitis media or ear infection, chronic otitis media, chronic tympanic membrane perforation, Eustachian tube dysfunction (ETD), recurrent acute otitis media, wet tympanic membrane perforation, and any of the above with associated pathology. The table lists what to submit for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
C. ALL OTHERS Active acute Otitis Media/ear infection Chronic Otitis Media Chronic tympanic membrane perforation Eustachian Tube Dysfunction (ETD) Recurrent Acute Otitis Media Wet tympanic membrane perforation Any of the above with associated pathology Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
If the examiner defersSpecial Issuance
The table marks Row C, all others, DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note generated from a clinic visit with the otolaryngologist (ENT) or PCP no more than 90 days before the exam, including what the table lists.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row C, all others, DEFER.
C. ALL OTHERS Active acute Otitis Media/ear infection Chronic Otitis Media Chronic tympanic membrane perforation Eustachian Tube Dysfunction (ETD) Recurrent Acute Otitis Media Wet tympanic membrane perforation Any of the above with associated pathology … DEFER Submit the information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
A current, detailed clinical progress note generated from a clinic visit with the otolaryngologist (ENT) or PCP no more than 90 days before the exam, including what the table lists.
1. A current, detailed Clinical Progress Note generated from a clinic visit with the otolaryngologist (ENT) or PCP no more than 90 days prior to the AME exam. It must include:
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workGood to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
No mandatory recovery period after PE tubes, other than wait time for general anesthesia (if used)
Row A's note says there is no mandatory recovery period after PE tubes are placed other than wait time for general anesthesia (if used). The table does not give that wait time.
Show the FAA's words: good to know, 2
Note: There is no mandatory recovery period after PE tubes are placed other than wait time for General anesthesia (if used).
Row B's words, as printed
Row B reads "the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties", with "AND The individual can pass any of the acceptable hearing tests". The page shows these words as printed.
Show the FAA's words: good to know, 3
If the AME can determine the condition has resolved without sequelae or no symptoms or current problems that would interfere with flight duties AND The individual can pass any of the acceptable hearing tests:
Eardrum perforations are in two rows
Row B lists a tympanic membrane perforation (dry), under RESOLVED, marked ISSUE. Row C lists a chronic tympanic membrane perforation and a wet tympanic membrane perforation, marked DEFER. The table does not say which row a chronic perforation that is dry falls under.
Show the FAA's words: good to know, 4
B. RESOLVED Otitis media/ ear infection Tympanic membrane perforation (dry) … C. ALL OTHERS Active acute Otitis Media/ear infection Chronic Otitis Media Chronic tympanic membrane perforation … Wet tympanic membrane perforation … DEFER Submit the information to the FAA for a possible Special Issuance
Any of the above with associated pathology
Row C's list ends with any of the above with associated pathology. The table does not say which entries "the above" covers.
Show the FAA's words: good to know, 5
Any of the above with associated pathology
The table lists no hearing test
Row B's ISSUE rests in part on the individual being able to pass any of the acceptable hearing tests. The table does not list those tests.
Show the FAA's words: good to know, 6
AND The individual can pass any of the acceptable hearing tests:
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.