Hearing for class 2 and 4 medicals

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Hearing for class 2 and 4 medicals

Unread post by GL » Fri Apr 26, 2019 11:05 am

Can anyone tell me whether the hearing requirements are the same for class 2 and 4?
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Re: Hearing for class 2 and 4 medicals

Unread post by Flymed » Fri Apr 26, 2019 1:00 pm

Exactly the same.
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Re: Hearing for class 2 and 4 medicals

Unread post by GL » Fri Apr 26, 2019 1:09 pm

Thanks. Is the CAA accepting 'whisper' tests?
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Re: Hearing for class 2 and 4 medicals

Unread post by Flymed » Sat Apr 27, 2019 10:49 am

Whisper tests (which is rubbish :wink: ) are accepted as interval testing. So, every now and then depending on medical class and age, a normal audiogram is required, and the in between examinations will be whisper tests.
I say it is rubbish because there is no scientific or practical basis for it to base any finding of audiological fitness on.
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Re: Hearing for class 2 and 4 medicals

Unread post by Orthin Opter » Mon Apr 29, 2019 9:16 am

Flymed wrote:
Sat Apr 27, 2019 10:49 am
Whisper tests (which is rubbish :wink: ) are accepted as interval testing. So, every now and then depending on medical class and age, a normal audiogram is required, and the in between examinations will be whisper tests.
I say it is rubbish because there is no scientific or practical basis for it to base any finding of audiological fitness on.
With due respect sir, testing a low time PPL in a B738 simulator for audio and monocular reasons, is also rubbish.
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Re: Hearing for class 2 and 4 medicals

Unread post by Flooi » Mon Apr 29, 2019 2:23 pm

Orthin Opter wrote:
Mon Apr 29, 2019 9:16 am
Flymed wrote:
Sat Apr 27, 2019 10:49 am
Whisper tests (which is rubbish :wink: ) are accepted as interval testing. So, every now and then depending on medical class and age, a normal audiogram is required, and the in between examinations will be whisper tests.
I say it is rubbish because there is no scientific or practical basis for it to base any finding of audiological fitness on.
With due respect sir, testing a low time PPL in a B738 simulator for audio and monocular reasons, is also rubbish.
Bit like a resting ECG... looks good, but is it of any use? Just wondering...
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Re: Hearing for class 2 and 4 medicals

Unread post by Flymed » Tue Apr 30, 2019 7:50 am

I absolutely agree with OO, but I cannot see what my comment has to do with simulator based testing of hearing. I answered a question that had nothing to do with the use of simulators.
So, yes, using simulators for many of the medical conditions it is been used for today is of no practical use whatsoever in my humble opinion, and should be acted upon by those who can act!
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Re: Hearing for class 2 and 4 medicals

Unread post by fcvanwyk » Wed May 01, 2019 9:10 pm

As an ENT I use whisper tests every day to decide on whether to refer for audiological testing or not. The problem is in the lack of teaching and understanding of the whisper test. Its not as robust as a pure tone or speech audiogram but certainly useful as a guide and a whole lot less expensive than seeing an audiologist. I think the whisper test is a sensible option the way it has been intended by the regs as an in between check.
Regarding the original question the current situation is that Class 1 and 2 are similar but class 4 is very much more lax. I have posted the regs before in a related topic discussion under Deaf pilots as the audiological standards were amended to get them in line with ICAO in 2017. This meant for Class 1 to 3 on a pure tone audiogram for both ears individually the hearing at 500, 1000 and 2000Hz needs to be above 35 db and the hearing at 3000Hz at 50db or better. Note as far as I understand this is a corrected hearing and may be with a strong hearing aid in during the test even if u will not be flying with a hearing aid in. For Class 4 the regs are along the line of showing an ability to communicate... if there is a need I will go find it but suffice to say its a lot less stringent. Which is why you may still get a class 4 when u fail a class 2. The argument is that class 4 is outside of ICAO and the Class 4 pilot may operate outside of controlled airspace where radio comms are not as critical. GL feel free to pm me if needed.
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Re: Hearing for class 2 and 4 medicals

Unread post by Flymed » Fri May 03, 2019 2:12 pm

Hallo Carl
The whisper test is a good clinical tool, but not for regulatory purposes as the definition of a whisper test as used cannot be quantitatively used and is in part also a test of the examiner's ability to hear. The regulations tries to cover audiological values that is based on audiometry, but use non-scientific means to achieve it. This includes the whisper test as well as the use of flight training simulators. None of these can quantify a person's hearing to satisfy the demands required by a specific aircraft, cabin, ANR set, noise interferences, vibration interference, etc.
The gold standard should be, like it used to be, an assessment of an individual's ability to communicate accurately with communicators applicable to his flight profile, aircraft and hearing augmentation used. This alone should be the regulatory requirement, as all applicable regulations are there to define the safety boundaries where within aviation happens.
Standard audiometric screeners can eliminate the normal values based on set standards, but whisper testing cannot. The subsequent testing in simulators cannot by any means duplicate the criteria needed for a person to be fair to him, nor can it discern where the transition from safe to unsafe happens.
Referral to an audiologist/ ENT seems like a good idea, but again, this is not the purpose of aviation medicine. Do not confuse the aviation safety role of audio screening with the clinical and corrective purpose of further medical assessments. The regulator must allow or disallow someone his licence; not prescribe any corrective medicine or procedures. This is the prerogative of the person being tested. This is therefore a clinical function outside of the regulatory function of the DAME.
Over regulation is possibly more dangerous than under regulation: It kills the sport as fast as it kills the honesty required!
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Re: Hearing for class 2 and 4 medicals

Unread post by Chalkie » Sun May 05, 2019 9:22 am

Flymed wrote:
Fri May 03, 2019 2:12 pm
The whisper test is a good clinical tool, but not for regulatory purposes as the definition of a whisper test as used cannot be quantitatively used and is in part also a test of the examiner's ability to hear. The regulations tries to cover audiological values that is based on audiometry, but use non-scientific means to achieve it. This includes the whisper test as well as the use of flight training simulators. None of these can quantify a person's hearing to satisfy the demands required by a specific aircraft, cabin, ANR set, noise interferences, vibration interference, etc.

The gold standard should be, like it used to be, an assessment of an individual's ability to communicate accurately with communicators applicable to his flight profile, aircraft and hearing augmentation used. This alone should be the regulatory requirement, as all applicable regulations are there to define the safety boundaries where within aviation happens.
Standard audiometric screeners can eliminate the normal values based on set standards, but whisper testing cannot. The subsequent testing in simulators cannot by any means duplicate the criteria needed for a person to be fair to him, nor can it discern where the transition from safe to unsafe happens.

Referral to an audiologist/ ENT seems like a good idea, but again, this is not the purpose of aviation medicine. Do not confuse the aviation safety role of audio screening with the clinical and corrective purpose of further medical assessments. The regulator must allow or disallow someone his licence; not prescribe any corrective medicine or procedures. This is the prerogative of the person being tested. This is therefore a clinical function outside of the regulatory function of the DAME.

Over regulation is possibly more dangerous than under regulation: It kills the sport as fast as it kills the honesty required!
Doctor, I salute you. Thank you for your realistic, pragmatic approach; if only you were the HOD of the SACAA's AvMed section.

Para 1: "None of these can quantify a person's hearing to satisfy the demands required by a specific aircraft, cabin, ANR set, noise interferences, vibration interference, etc."

The SACAA AvMed department insist I fly to Johannesburg to be tested in a Comair B738 simulator (My audio report is out of limits at 2000Hz and at 3000Hz) and all requests to be tested locally (Eastern Cape) has fallen on deaf ears although CATs and CARs allow for me to be tested by a DFE on an aircraft I am rated on, current on and valid on. I refuse to rent the B738 simulator as all I want is a PPL to fly light aircraft.

Para 2: Absolutely correct Doctor. SACAA AvMed department say they need to see if I can hear Marker Beacons!! When will a PPL EVER fly over a marker beacon (Assuming he had the equipment to pick up a marker beacon?)

Note to SACAA AvMed Department: Marker Beacons are no longer used. Most (If not all) ILS systems use DME for height check.

The SACAA AvMed Department also want to see if I can hear the approach to stall in the B738 simulator.

Note to SACAA AvMed Department: The noise created at approach to stall is low frequency. I can hear those and there are also other aerodynamic indications that pilots are aware of.

"Over regulation is possibly more dangerous than under regulation: It kills the sport as fast as it kills the honesty required!"

Absolutely correct Doctor. =D> =D> =D>
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Re: Hearing for class 2 and 4 medicals

Unread post by fcvanwyk » Sun May 05, 2019 10:33 am

Flymed wrote:
Fri May 03, 2019 2:12 pm
Hallo Carl
The whisper test is a good clinical tool, but not for regulatory purposes as the definition of a whisper test as used cannot be quantitatively used and is in part also a test of the examiner's ability to hear. The regulations tries to cover audiological values that is based on audiometry, but use non-scientific means to achieve it. This includes the whisper test as well as the use of flight training simulators. None of these can quantify a person's hearing to satisfy the demands required by a specific aircraft, cabin, ANR set, noise interferences, vibration interference, etc.
The gold standard should be, like it used to be, an assessment of an individual's ability to communicate accurately with communicators applicable to his flight profile, aircraft and hearing augmentation used. This alone should be the regulatory requirement, as all applicable regulations are there to define the safety boundaries where within aviation happens.
Standard audiometric screeners can eliminate the normal values based on set standards, but whisper testing cannot. The subsequent testing in simulators cannot by any means duplicate the criteria needed for a person to be fair to him, nor can it discern where the transition from safe to unsafe happens.
Referral to an audiologist/ ENT seems like a good idea, but again, this is not the purpose of aviation medicine. Do not confuse the aviation safety role of audio screening with the clinical and corrective purpose of further medical assessments. The regulator must allow or disallow someone his licence; not prescribe any corrective medicine or procedures. This is the prerogative of the person being tested. This is therefore a clinical function outside of the regulatory function of the DAME.
Over regulation is possibly more dangerous than under regulation: It kills the sport as fast as it kills the honesty required!
Dear Flymed,
Excellent post and we agree on all points esp the over regulation, which is why I prefer the whisper test to further expense. Your years of experience shows and I am at a loss as to why doctors of your insight and experience are not the ones advising the SACAA.

From my limited exposure to the field of aviation medicine I would like to add that we do have a problem to sort out. The screening audiogram is a good start. We have standards and if passed all are happy. But we also have some who do not. The regs then ask for a speech audiogram and diagnostic audiogram. The speech audiogram should be aviation related. Having seen one of these avaition related audiograms its clear that there is a lack of training and insight on the part of the audiologist as to what is needed. At a recent audiology congress the audience seemed to agree. Asking someone to repeat terms that they are then required to read back to you is what the speech audiogram is all about. However, the pilot being tested is (rightly so) expecting to hear what they would be hearing on an aviation band radio. But then to get asked to repeat a term such as "Air Mauritius" most GA pilots would doubt they are hearing right. On the other hand, the audiologist is expecting to do the test the way they are trained, without hearing aids or ampifying aviation headphones. But in this situation the pilot may be fitted with hearing aids and then tested. This is getting very far removed from the reality of the environment the pilot in a cockpit experiences.
I suspect this is what prompted the CAA to start trying out a simulator. While the use of the a sim for colour blindness makes some sense...excluding the cost factor... the comair sim does not realistically represent the GA environment. Changing to a cheaper sim is also not likely to give enough benefit.

While in the past the DFE could make the call after testing I suspect CAA would rather have something more scientific than a possibly subjective opinion.

What makes this especially challenging is that while the concept of being able to hear over the radio is obviously important, we are all on a spectrum of ability to hear over the radio. This is affected by multiple factors, some outside of our control. The stength of the signal, distance from the other aircraft, the accent of the sender, the cockpit ambient noise, the quality of the radio and headset being used to name a few all may affect the pilot's ability to hear the message. So at what point does a pilot qualify to have a medical and is considered safe or not?

I would suggest there should be quite a bit of research done on quantifying what constitutes the normal spectrum of hearing and understanding by normal pilots and a practical test should on that basis be developed to show where a particular pilot lies on the spectrum. The test should incorporate the actual aircraft including the radio and actual headset used and the conditions at the field the pilot operates from. I am not aware of anything that fits this bill but perhaps the research is available. Are you aware of other CAA's doing research on this Flymed?
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Re: Hearing for class 2 and 4 medicals

Unread post by Chalkie » Sun May 05, 2019 11:21 am

fcvanwyk wrote:
Sun May 05, 2019 10:33 am
Dear Flymed,
Excellent post and we agree on all points esp the over regulation, which is why I prefer the whisper test to further expense. Your years of experience shows and I am at a loss as to why doctors of your insight and experience are not the ones advising the SACAA.

From my limited exposure to the field of aviation medicine I would like to add that we do have a problem to sort out. The screening audiogram is a good start. We have standards and if passed all are happy. But we also have some who do not. The regs then ask for a speech audiogram and diagnostic audiogram. The speech audiogram should be aviation related. Having seen one of these avaition related audiograms its clear that there is a lack of training and insight on the part of the audiologist as to what is needed. At a recent audiology congress the audience seemed to agree. Asking someone to repeat terms that they are then required to read back to you is what the speech audiogram is all about. However, the pilot being tested is (rightly so) expecting to hear what they would be hearing on an aviation band radio. But then to get asked to repeat a term such as "Air Mauritius" most GA pilots would doubt they are hearing right. On the other hand, the audiologist is expecting to do the test the way they are trained, without hearing aids or ampifying aviation headphones. But in this situation the pilot may be fitted with hearing aids and then tested. This is getting very far removed from the reality of the environment the pilot in a cockpit experiences.
I suspect this is what prompted the CAA to start trying out a simulator. While the use of the a sim for colour blindness makes some sense...excluding the cost factor... the comair sim does not realistically represent the GA environment. Changing to a cheaper sim is also not likely to give enough benefit.

While in the past the DFE could make the call after testing I suspect CAA would rather have something more scientific than a possibly subjective opinion.

What makes this especially challenging is that while the concept of being able to hear over the radio is obviously important, we are all on a spectrum of ability to hear over the radio. This is affected by multiple factors, some outside of our control. The stength of the signal, distance from the other aircraft, the accent of the sender, the cockpit ambient noise, the quality of the radio and headset being used to name a few all may affect the pilot's ability to hear the message. So at what point does a pilot qualify to have a medical and is considered safe or not?

I would suggest there should be quite a bit of research done on quantifying what constitutes the normal spectrum of hearing and understanding by normal pilots and a practical test should on that basis be developed to show where a particular pilot lies on the spectrum. The test should incorporate the actual aircraft including the radio and actual headset used and the conditions at the field the pilot operates from. I am not aware of anything that fits this bill but perhaps the research is available. Are you aware of other CAA's doing research on this Flymed?
Dr van Wyk, I appreciate your pragmatic approach too. I did undergo the speech test audiogram, but unfortunately the words used were everyday words and not aviation orientated. You see, when an ATC instruction or clearance is given, it follows a specific format and most words or phrases can be anticipated. So the 'civvie' style audio speech did, in my case, confirm the loss of hearing in the 3000Hz band. I do not deny the loss of hearing, all I am asking is that the SACAA follow the law as published. If DFE's are allowed to test initial and renewal of Pilot licences and ratings, then they should be trusted to test a pilots audio capability and monocular vision related flying ability.

Recently I was informed that DAME's have to visit the same B738 simulator, for what? I have no idea...

I did try to explain to Dr Mbatha, of the SACAA Avmed Department, that although I have the B738 rating in my licence; I was not current, not valid and did not plan to ever fly one again. So in my opinion the flight test in the simulator is a waste of time and money. (80 hour PPL's have reported being tested there. This is wrong in my opinion.)

I offered to take the R10 000 I was expected to pay for bills sent to me and put this towards having two hearing aids fitted. I would then produce a corrected hearing audiogram that was perfect. "NO! Not good enough, you will still have to do the simulator test!" (Annually?) Now I wonder what the SACAA Avmed Department does with pilots with corrected vision? Do they ALL have to do a simulator test too?

As for the statement that a test with a DFE in an aircraft might be a subjective opinion; well I guess that could also be said about the SACAA simulator test. Not so?

As with the SACAA / Cemair debacle, where the SACAA were reprimanded for overstepping the boundaries of their authority, so too (in my opinion) is the SACAA Avmed Department guilty of overstepping their authority and causing unnecessary anxiety and expense for the pilot fraternity. Hopefully sanity will prevail before a Class Action lawsuit takes place.
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Re: Hearing for class 2 and 4 medicals

Unread post by Flymed » Sun May 05, 2019 6:35 pm

I may be wrong, but to my knowledge there is no research going on at present or in the past related to this.
The reason is that it is not needed.
The DFE does not make the call. The pilot does. In the practical flight test scenario there is no subjective examination going on, but rather objective. I know; I did these examinations. The DFE only records the resultant effect after initiating the communications with talking, commands and monitoring of external communications. The testing of the pre-solo pilot is even easier because the training cannot continue beyond the solo phase if there is a safety concern regarding the ability to communicate. ( On this point I would like to say that audibility on the side of the speaking person, whether the pilot or ATC or anyone else should rather be investigated, because inaudible speaking is a problem across all spectra of comms and is a real safety issue. Words said without proper pronunciation can be misinterpreted by the most acute set of ears!)
The principle is based on the pilot's response, either verbally or by executing appropriate actions based on communications with the flight instructor, ATC, other pilots flying, aircraft system demands, etc., as in a normal flying situation, as required for the specific licence held by the pilot and in the aircraft the pilot flies. There is no grey area in this situation that may warp the results. When comms are bad, as it often is, the same comms is heard by the instructor and the examiner. This makes it a very accurate standardisation of the test, and should be allowed as a definitive gold standard test. If a pilot agrees to simulator testing in a simulator not known to him/her, they are at a distinct disadvantage.
This is also the reason why the medical assessor must be equally qualified as a pilot, because someone who is not will not be able to discern a string of words said over the radio or internal comms, and even worse when ANRs are used in some situations due to the initial cut-off of a communication string. Sadly, the assessors are mostly not aviators themselves, and must rely on their impressions of what is happening in the cockpit.

Yes, research would be very interesting, but will not really contribute to aviation safety more than a simple flight test can. I am all for research, but then the research must add to our ability to make aviation safer. If the purpose is to investigate hearing deficiencies outside of the safety parameters it must be done in such a way that it will not cost the aviator (or ATC) his/her career or chosen hobby by ignoring the purpose of aviation comms in the first place.
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Re: Hearing for class 2 and 4 medicals

Unread post by Chalkie » Sun May 05, 2019 8:53 pm

Flymed wrote:
Sun May 05, 2019 6:35 pm
This is also the reason why the medical assessor must be equally qualified as a pilot, because someone who is not will not be able to discern a string of words said over the radio or internal comms, and even worse when ANRs are used in some situations due to the initial cut-off of a communication string.
Thanks for the reply, but could you please clarify how an ANR headset can cause 'initial cut-off of a communication string.'

I can see the possibility of this happening but have never noticed it and have been using ANR headsets since 2003.

Basically an ANR headset measures the ambient noise within the earpiece and introduces the same noise 180 degrees out of phase. Are you saying it is possible for audio over the speaker to be included in this noise cancellation?

Again, I must say, I have never noticed this at all.
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Re: Hearing for class 2 and 4 medicals

Unread post by Flymed » Mon May 06, 2019 9:48 am

Chalkie, this is from the perspective of someone (the medical assessor) that is not used to ANR functioning. The earlier ANR's still in use had a marked lag in initiating a string of "talk".

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