Perilymph fistula
What the FAA's documents say about perilymph fistula, in plain words, with the FAA's own words one press away.
FAA term: Perilymph Fistula (PLF)Covers: All classes
Short version
The FAA's table sorts it into two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AResolved 5 or more years ago | Examiner issues | Examiner can issue |
| Row BFirst time reported to the FAA, or a new episode in the last 5 years | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Perilymph fistula
- Row A · Examiner can issue
Resolved 5 or more years ago. The table says the examiner should review the most recent detailed clinical progress note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes, the table says ISSUE. The examiner annotates Block 60 and submits the ENT evaluation to the FAA for retention in the file.
A. Resolved 5 or more years ago. … The AME should review the most recent detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes: … ISSUE Annotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
- Row B · Special Issuance
The first time the condition is reported to the FAA, or a new episode within the last 5 years (the table's words, as printed). The row says that once resolved and after a recovery period of one (1) month after surgery, or three (3) months if treated medically or with observation, and showing no further vertiginous attacks and hearing that remains within standards, the following is submitted for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance, and the table says follow-up issuance will be per the Authorization letter.
B. FIRST time the condition is reported to the FAA OR A new episode Within the last 5 years. … Once resolved and recovery period of: • One (1) month after surgery; or • Three (3) months if treated medically or with observation; and • Showing no further vertiginous attacks and hearing remains within standards. Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the Authorization Letter
The FAA pathways for perilymph fistula
Which exam
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: the progress note and what the examiner reviews
Resolved 5 or more years ago.The most recent detailed progress note from a clinic visit with your treating otolaryngologist (ENT) or neurotologist, which your AME should review.
The table says ISSUE if it verifies
- The treatment has been completed (surgical or medical)
- No further episodes
At the exam
- Your AME annotates Block 60
- Your AME submits the ENT evaluation to the FAA for retention in the file
Show the FAA's words: Row A: the progress note and what the examiner reviews
The AME should review the most recent detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist.
FAA source: Perilymph Fistula (PLF). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
If it verifies the treatment has been completed (surgical or medical) and no further episodes:
ISSUE
FAA source: Perilymph Fistula (PLF). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
A. Resolved 5 or more years ago.
FAA source: Perilymph Fistula (PLF). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
ISSUE Annotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
FAA source: Perilymph Fistula (PLF). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
Step 2: See your AME
The table says the examiner should review the most recent detailed clinical progress note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes, the table says ISSUE. The examiner annotates Block 60 and submits the ENT evaluation to the FAA for retention in the file.Exam day- The table says the examiner should review the most recent detailed clinical progress note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes, the table says ISSUE. The examiner annotates Block 60 and submits the ENT evaluation to the FAA for retention in the file.
Show the FAA's words: See your AME
A. Resolved 5 or more years ago.
The AME should review the most recent detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes:
ISSUE Annotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
FAA source: Perilymph Fistula (PLF). FAA date 29 November 2023; 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
The table says the examiner should review the most recent detailed clinical progress note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes, the table says ISSUE. The examiner annotates Block 60 and submits the ENT evaluation to the FAA for retention in the file.
Row BDefers to the FAASpecial Issuance
The row says that once resolved and after a recovery period of one (1) month after surgery, or three (3) months if treated medically or with observation, and showing no further vertiginous attacks and hearing that remains within standards, the following is submitted for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance, and the table says follow-up issuance will be per the Authorization letter.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Resolved 5 or more years ago. The table says the examiner should review the most recent detailed clinical progress note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes, the table says ISSUE. The examiner annotates Block 60 and submits the ENT evaluation to the FAA for retention in the file.
A. Resolved 5 or more years ago. … The AME should review the most recent detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. If it verifies the treatment has been completed (surgical or medical) and no further episodes: … ISSUE Annotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
- Row B · Special Issuance
The first time the condition is reported to the FAA, or a new episode within the last 5 years (the table's words, as printed). The row says that once resolved and after a recovery period of one (1) month after surgery, or three (3) months if treated medically or with observation, and showing no further vertiginous attacks and hearing that remains within standards, the following is submitted for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance, and the table says follow-up issuance will be per the Authorization letter.
B. FIRST time the condition is reported to the FAA OR A new episode Within the last 5 years. … Once resolved and recovery period of: • One (1) month after surgery; or • Three (3) months if treated medically or with observation; and • Showing no further vertiginous attacks and hearing remains within standards. Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the Authorization Letter
If the examiner defersSpecial Issuance
The table marks Row B, the first time the condition is reported to the FAA, or a new episode within the last 5 years, DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days before the exam.
- Item 2. The table's second item, which reads that it must include the items it lists.
- Item 3. Items the physician specifically addresses: if active disease exists and, if in remission, when remission commenced. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
- Item 4. A current clinical audiogram with air-conduction/bone-conduction (AC/BC) and speech discrimination (SD), performed within the past 90 days.
- Item 5. Additional tests such as ECOG, VEMP, or an MRI with gadolinium of the cerebellopontine angle (CPA), performed as clinically indicated.
- Item 6. All office treatment records.
- Item 7. A copy of the operative report if surgery was performed.
- Item 8. A typed personal statement stating the number of attacks, the severity, the type of symptoms, episodes of hearing loss over the last year, what type of therapy or medication(s) are used for control, and how the episode occurred, for example childbirth, straining, weightlifting, or a lightning strike.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row B, the first time the condition is reported to the FAA, or a new episode within the last 5 years, DEFER.
B. FIRST time the condition is reported to the FAA OR A new episode Within the last 5 years. … 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 from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days before the exam.
1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days prior to the AME exam.
- Item 2
The table's second item, which reads that it must include the items it lists.
2. It must include: • A detailed summary of the history of the condition;
- Item 3
Items the physician specifically addresses: if active disease exists and, if in remission, when remission commenced. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
3. It must specifically include: a. If active disease exists. b. If in remission, when did remission commence.
“IT MUST SPECIFICALLY INCLUDE” If this language is in your letter, it is to highlight SPECIFIC items (that may or may not be part of a standard current, detailed Clinical Progress Note). Make sure your physician addresses these specific items important for medical certification or clearance.
- Item 4
A current clinical audiogram with air-conduction/bone-conduction (AC/BC) and speech discrimination (SD), performed within the past 90 days.
4. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discrimination (SD) (performed within the past 90 days).
- Item 5
Additional tests such as ECOG, VEMP, or an MRI with gadolinium of the cerebellopontine angle (CPA), performed as clinically indicated.
5. Additional tests such as (ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.) performed as clinically indicated.
- Item 6
All office treatment records.
6. All Office treatment records.
- Item 7
A copy of the operative report if surgery was performed.
7. Copy of Operative report if surgery performed.
- Item 8
A typed personal statement stating the number of attacks, the severity, the type of symptoms, episodes of hearing loss over the last year, what type of therapy or medication(s) are used for control, and how the episode occurred, for example childbirth, straining, weightlifting, or a lightning strike.
8. Personal statement (typed) stating: a. Number of attacks; b. Severity; c. Type of symptoms; d. Episodes of hearing loss over the last year; e. What type of therapy or medication(s) are used for control; and f. How did the episode occur? (e.g., childbirth, straining, weightlifting, lightning strike, etc.).
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 workAt later examsSpecial Issuance
The disposition table is headed All Classes.
Show the FAA's words: how often the FAA asks again
PERILYMPH FISTULA (PLF) All Classes
For Row B the table says follow-up issuance will be per the Authorization letter.
Show the FAA's words: at later exams
Follow up Issuance Will be per the Authorization Letter
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 workFollow-up issuance per the Authorization letter
For Row B the table says follow-up issuance will be per the Authorization letter.
Show the FAA's words: Follow-up issuance per the Authorization letter
Follow up Issuance Will be per the Authorization Letter
Good 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.
How the two rows name 5 years
Row A is resolved 5 or more years ago. Row B is the first time the condition is reported to the FAA, or a new episode within the last 5 years. The table does not say whether "within the last 5 years" goes with both or only with a new episode, and this page quotes both rows as printed.
Show the FAA's words: good to know, 2
A. Resolved 5 or more years ago. … B. FIRST time the condition is reported to the FAA OR A new episode Within the last 5 years.
Row B names a recovery period
Row B says that once resolved and after a recovery period of one (1) month after surgery, or three (3) months if treated medically or with observation, and showing no further vertiginous attacks and hearing that remains within standards, the list that follows is submitted for FAA review.
Show the FAA's words: good to know, 3
Once resolved and recovery period of: • One (1) month after surgery; or • Three (3) months if treated medically or with observation; and • Showing no further vertiginous attacks and hearing remains within standards. Submit the following for FAA review:
Row B's list runs onto a second page
Items 5 to 8 of the list are printed on the table's second page, with no row letter beside them. Only Row B has a numbered list, and the numbers carry on from it, so this page shows them as the rest of Row B's list.
Show the FAA's words: good to know, 4
4. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discrimination (SD) (performed within the past 90 days). … 5. Additional tests such as (ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.) performed as clinically indicated.
Row A sends the ENT evaluation to the FAA
Row A is ISSUE. Its evaluation column names the most recent detailed clinical progress note from the treating otolaryngologist (ENT) or neurotologist, and its disposition column has the examiner annotate Block 60 and submit the ENT evaluation to the FAA for retention in the file. This page keeps both names as printed.
Show the FAA's words: good to know, 5
The AME should review the most recent detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist. … ISSUE Annotate Block 60 and submit the ENT evaluation to the FAA for retention in the file.
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.