In situ grommet and fitness for flying

Introduction: Current policies followed in the country do not permit aircrew to fly with in situ grommet. This paper discusses the aeromedical implications of in situ grommet, assessment of its flying fitness, and the factors which may be considered for possible reflighting of such cases. Case Details: A 19 year old civil pilot developed otitic barotrauma middle ear (right) which was managed with the placement of grommet in the tympanic membrane (TM). He was awarded fitness to fly on removal of grommet and after complete closure of the residual TM perforation. Another case, a 50 year old military pilot, a case of chronic suppurative otitis media (inactive) left ear, after uneventful recovery, was awarded flying medical category initially for in situ grommet and subsequently for single dry perforation TM in the left ear with an waiver from the competent medical authority. Discussion: Insertion of grommet, in cases with middle ear effusion and/or infection following Eustachian tube dysfunction, is a common practice to promote early recovery. However, as per the current policies in India, such aircrew are considered unfit for flying duty. Policies in other countries, military and civil, are mostly silent. This paper recommends the award of flying fitness for aircrew with in situ grommet provided that the clinical condition is stable, there are no complications and hearing is normal. This paper also discusses the award of flying fitness for aircrew with single and uncomplicated TM perforation with normal hearing for a specific type of aircraft.