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A visit to the dentist will be able to provide a preliminary diagnosis and the dentist can include additional specialists, as needed.
As a pilot, it is important to stay aware of the mental and physical standards required for the type of flying done. Most pilots must have a valid medical certificate to exercise the privileges of their airman certificates.
To acquire a medical certificate, an examination by an aviation medical examiner (AME), a physician with training in aviation medicine designated by the Civil Aerospace Medical Institute (CAMI), is required. HYPEMIC HYPOXIA This occurs when the blood is not able to take up and transport a sufficient amount of oxygen to the cells in the body.
Cyanosis (blue fingernails and lips) Headache Decreased reaction time Impaired judgment Euphoria Visual impairment Drowsiness Lightheaded or dizzy sensation Tingling in fingers and toes Numbness As hypoxia worsens, the field of vision begins to narrow, and instrument interpretation can become difficult. Pilots encountering an unexpected stressful situation may unconsciously increase their breathing rate. Climbs and descents can sometimes cause ear or sinus pain and a temporary reduction in the ability to hear. Spatial disorientation specifically refers to the lack of orientation with regard to the position, attitude, or movement of the airplane in space.
All this information comes together in the brain, and most of the time, the three streams of information agree, giving a clear idea of where and how the body is mov-ing.
Figure 15-3.The semicircular canals lie in three planes, and sense motions of roll, pitch, and yaw.
The postural system sends signals from the skin, joints, and muscles to the brain that are interpreted in relation to the earth’s gravitational pull.
Motion sickness, or airsickness, is caused by the brain receiving conflicting messages about the state of the body. It is important to remember that experiencing airsick-ness is no reflection on one’s ability as a pilot. Carbon monoxide (CO) is a colorless and odorless gas produced by all internal combustion engines.
Stress falls into two broad categories, including acute stress (short term) and chronic stress (long term).
The alcohol consumed in beer and mixed drinks is ethyl alcohol, a central nervous system depressant. Pilot performance can be seriously degraded by both prescribed and over-the-counter medications, as well as by the medical conditions for which they are taken.
It is estimated that once fully adapted to darkness, the rods are 10,000 times more sensitive to light than the cones, making them the primary receptors for night vision. Corneacornea (the transparent window on the front of the eye) and then through the lens to focus on the retina.The pupil (aperture) is the opening at the center of the iris.
AUTOKINESIS Autokinesis is caused by staring at a single point of light against a dark background for more than a few seconds. A safety-conscious crew needs to know how and when hearing-related issues are likely to affect performance. At a very basic level, the ability to hear a signal will affect a pilot’s ability to respond to that signal. When measuring sound in air, sound pressure level is almost always expressed in decibels (Figure 1). Eustachian tube extends from the middle ear to the nasopharynx, permitting air to enter or leave the middle ear cavity. Ossicles consist of three linked and movable bones that convert sound waves striking the eardrum into mechanical vibrations.
The inner ear (Figure 4) consists of two inter-connected pathways for the vestibular and auditory systems.
Extra-auditory effects occur when biological and complex cognitive processes are affected by noise. Most notably, noise can cause an increase in heart rate, vaso-constriction, digestive activity and muscular tension. Results showed that noise had no significant effect on performance in the one-clock condition, but in the the three-clock condition, the higher level of noise significantly decreased performance (Figure 5).
Hockey further explored this topic in an experiment where subjects were asked to perform a tracking task and a detection task at the same time (Figure 6). Figure 8 shows that this shift can reach up to 40 dB after exposure to 106 dB for 100 minutes. Figure 9 shows that a TTS can last for several hours and up to 45 hours for frequencies around 5,000 Hz where many components of speech are found. Approximately 10 percent of the population in industrialized societies has significant hearing loss. A PTS may occur after a short exposure to noise higher than 90 dB or as a result of cumulative exposure to relatively moderate levels of noise, such as 70 dB. After prolonged exposure to increased noise levels, a person may experience a temporary threshold shift where signals must be “louder” than normal to be heard by the individual.
Endolymphatic sac tumors are very rare tumors (adenomas) arising at the interface between the posterior fossa and the petrous temporal bone.
Hemangioblastoma lesions in spinal cord and cerebellum in patient with Von Hippel Lindau disease, who also had an endolymphatic sac tumor.
Some of these tumors are associated with von Hippel Lindau disease (VHL), which is characterized by angiomatosis of the retina and cerebellum and similar lesions in other organs.
Damage is due to destruction of the ear and involvement of close by neurological structures. Radiological studies show temporal bone destruction with a tumor centered in the retrolabyrinthine petrous bone above the jugular bulb at the interface between the posterior fossa dura and petrous temporal bone. It is critical that a good understanding of these causes is built so as to be able to provide an accurate diagnosis. Growth of new bones disrupts the arrangement of the arteries, veins, nerves and muscles on the jaw which can cause pain.
Habits which put so much work on the jaw such as nail biting and chewing gum can cause inflammation on the joint and result to severe pain. The medical history is a crucial element of the patient-dentist relationship as it gives the dentist key information to perform diagnosis. In Bruxism and TMJ disorder, there is continuous clenching of the teeth which can even occur when the patient is sleeping. Aside from painkillers, medications will need to be taken to ensure that the cause of the pain is controlled, if not eliminated.
Dentist enrolls other specialists to help on managing other conditions which lead to jaw pain on one side. This chapter provides information on medical certification and on aeromedical factors related to flying activities. A blocked airway or drowning are obvious examples of how the lungs can be deprived of oxygen, but the reduction in partial pressure of oxygen at high altitude is an appropriate example for pilots. An arm or leg going to sleep because the blood flow has accidentally been shut off is one form of stagnant hypoxia. Even with all these symptoms, the effects of hypoxia can cause a pilot to have a false sense of security and be deceived into believing that every-thing is normal. If fly-ing at higher altitudes, either with or without oxygen, a pilot may have a tendency to breathe more rapidly than normal, which often leads to hyperventilation. The physiological explanation for this discomfort is a difference between the pressure of the air outside the body and that of the air inside the middle ear and nasal sinuses.
The body uses three integrated systems working together to ascertain orientation and movement in space. Flying can sometimes cause these systems to supply conflicting information to the brain, which can lead to disorientation. A pilot may experience motion sickness during initial flights, but it generally goes away within the first few lessons.
If prone to motion sickness, let the flight instructor know since there are techniques that can be used to overcome this problem.
Since it attaches itself to the hemoglobin in the blood about 200 times more easily than oxygen, carbon monoxide pre-vents the hemoglobin from carrying oxygen to the cells, resulting in hypemic hypoxia. Smoking at sea level can raise the CO concentration in the blood and result in physiological effects similar to flying at 8,000 feet. Some of the effects of fatigue include degradation of attention and concentration, impaired coordination, and decreased ability to communicate. Onset of this condition may be recognized by the symptoms of dehydration, but also has been known to be recognized only by complete collapse. Studies have positively proven that drinking and performance deterioration are closely linked. Many medications, such as tranquilizers, sedatives, strong pain relievers, and cough-suppressants have primary effects that may impair judgment, memory, alertness, coordination, vision, and the ability to make calculations. Analgesics are drugs that reduce pain, while anesthetics are drugs that deaden pain or cause loss of consciousness. Its structure includes an aperture, a lens, a mechanism for focusing, and a surface for registering images. With nothing to focus on, the eyes automatically focus on a point just slightly ahead of the airplane. Since the cones are concentrated near the fovea, the rods are also responsible for much of the peripheral vision. The rods and cones (film) of the retina are the receptors which record the image and transmit it through the optic nerve to the brain for interpretation. When looking directly at an object, the image is focused mainly on the fovea, where detail is best seen.
Above feature-less terrain at night, there is a natural tendency to fly a lower-than-normal approach. This Briefing Note (BN) describes the process of hearing and issues that can arise related to it during flight. Modern aircraft designs put high demands on vision as the primary sense for information gathering, but such designs can lead to increased attentional demands that have the potential to decrease situational awareness. A signal could be missed because of physical problems related to the ear or because of environmental issues such as noise. This BN will discuss these problems and how various levels of noise affect hearing and performance.
Sound is simply a series of compressions (where molecules are dense) and rarefactions (where molecules are sparse). As a wave, sound has two main characteristics, frequency and amplitude, and a vibration occurs over a single wavelength.
The logarithmic decibel scale uses a reference sound pressure of 20 micro pascals (?Pa) which is considered the threshold of human hearing and is roughly equivalent to the sound of a piece of paper falling to the ground.
Sound waves are collected by the pinna and travel through the ear canal to the tympanic membrane (eardrum).
The process of hearing involves the transmission of vibrations and the generation of nerve impulses. Noise can act as a nonspecific physiologic stressor and can alter endocrine, cardiovascular and neurologic functions. Also, a 75 dB noise may change the diameter of the eye’s pupil, which can significantly impact visual acuity. However, from an operational point of view, one of the most important issues is how noise affects attention. This finding demonstrated that noise tends to decrease the ability to share attention between several concurrent tasks, especially when the tasks must be performed for extended periods of time. For the tracking task, the higher the percentage of time spent on the target, the better the performance. Simply put, an increase of 40 dB in a signal would be needed for a person to hear with the same acuity as before the exposure to the 106 dB noise for 100 minutes.
This is due to the generation of high levels of adrenaline that narrow blood vessel diameter resulting in increased blood pressure. Pathological effects of noise on hearing are known as a Permanent Threshold Shift (PTS), meaning the threshold of hearing has permanently increased.
This is due to the creation of high levels of adrenaline that narrow blood vessel diameter and the resultant increase in blood pressure. VHL is an inherited disorder associated with cysts in the kidneys, pancreas and male genital tract. MRI scans of large tumors show hyper and hypointensity on both T1 and T2 images with strong post-gadolinium enhancement. Agressive papillary adenoma of the cerebellopontine angle: Case report of an endolymphatic sac tumor. The trigeminal nerve has three branches including ophthalmic, maxillary and mandibular nerves which innervate almost all parts of the face.
Most of the primary pain causes can be prevented such frequently grinding, gum infection and bad habits can be prevented by conscious action and proper dental hygiene.
Sport pilots may hold either a medical certificate or a valid state driver’s license. Hypoxia can be caused by several factors including an insufficient supply of oxygen, inadequate transportation of oxygen, or the inability of the body tissues to use oxygen.
Although the percentage of oxygen in the atmosphere is constant, its partial pressure decreases proportionately as atmospheric pressure decreases. It may be because there is not enough blood volume (due to severe bleeding), or may result from certain blood diseases, such as ane-mia. This kind of hypoxia can also result from shock, the heart failing to pump blood effectively, or a constricted artery.
In this case, plenty of oxygen is being transported to the cells that need it, but they are unable to make use of it. One particularly noteworthy attribute of the onset of hypoxia is the fact that the first symptoms are eupho-ria and a carefree feeling. Since many of the symptoms of hyperventilation are similar to those of hypoxia, it is important to correctly diagnose and treat the proper condition.


Normally, pressure differences between the middle ear and the outside world are equalized by a tube leading from inside each ear to the back of the throat on each side, called the eustachian tube. During flight in visual meteorological conditions (VMC), the eyes are the major orientation source and usually prevail over false sensations from other sensory systems. Inputs from each movement update the body’s position to the brain on a constant basis. Anxiety and stress, which may be experienced at the beginning of flight training, can contribute to motion sickness. For example, avoid lessons in turbulent conditions until becoming more comfortable in the airplane, or start with shorter flights and gradu-ate to longer instruction periods.
Besides hypoxia, tobacco causes dis-eases and physiological debilitation that are medically disqualifying for pilots. It is the kind of tiredness people feel after a period of strenuous effort, excitement, or lack of sleep. To prevent these symptoms, it is recommended that an ample supply of water be carried and used at frequent intervals on any long flight, whether thirsty or not. Pilots must make hundreds of decisions, some of them time-critical, during the course of a flight. Others, such as antihistamines, blood pressure drugs, muscle relaxants, and agents to con-trol diarrhea and motion sickness have side effects that may impair the same critical functions.
Over-the-counter analgesics, such as acetylsalicylic acid (Aspirin), acetaminophen (Tylenol), and ibupro-fen (Advil) have few side effects when taken in the correct dosage.
As remarkable and vital as it is, vision is subject to some limitations, such as illusions and blind spots.
Light enters through the cornea at the front of the eyeball, travels through the lens and falls on the retina. Searching out and focusing on distant light sources, no matter how dim, helps prevent the onset of empty-field myopia.
The concentration of cones in the fovea can make a night blind spot in the center of the field of vision. At night, the ability to see an object in the center of the visual field is reduced as the cones lose much of their visual acuity and the rods become more sensitive.
To prevent this illusion, focus the eyes on objects at varying distances and avoid fixating on one target. Elements that cause any type of visual obscuration, such as rain, haze, or a dark runway environment also can cause low approaches. It will discuss the impact of noise on hearing and how performance is subsequently affected.
To compensate, sound has become more important for delivering information or to divert a pilot’s attention to an area that needs monitoring. Frequency is typically expressed in Hertz (Hz), a measure of how many vibrations occur in one second, and directly corresponds to the pitch of a sound (Table 1). When sound waves enter the ear canal, vibrations are transmitted by the following sequence of structures: eardrum, malleus, incus, stapes, oval window of the inner ear, perilymph and endolymph within the cochlea and hair cells of the organ of corti. These altered functions can cause biochemical changes that may have negative health effects. After three to five years of regular exposure to 85 dB noise, morbidity increased significantly increased. One of the difficulties of detecting PTS is that in the early stages a person may not be aware of any issues. There is also an increased risk of developing clear-cell renal cell carcinoma as well as pheochormocytoma. Nerves are made up of axons which are able to transmit impulses in the peripheral nervous system [3]. Once the dentist has eliminated possible primary pain causes, he can refer the patient to a licensed physician who will perform another round of assessment, perform diagnosis and facilitate treatment. With this, a lot of procedures and medications nowadays are made to resolve people pain problems with zero to minimal pain. The forms of hypoxia are divided into four major groups based on their causes: hypoxic hypoxia, hypemic hypoxia, stagnant hypoxia, and histotoxic hypoxia. As the airplane ascends during flight, the percentage of each gas in the atmosphere remains the same, but there are fewer mole-cules available at the pressure required for them to pass between the membranes in the respiratory system. More often it is because hemoglobin, the actual blood molecule that transports oxygen, is chemically unable to bind oxygen molecules. This impairment of cellular respiration can be caused by alcohol and other drugs, such as narcotics and poisons.
With increased oxygen starvation, the extremities become less responsive and flying becomes less coordinated.
All pilots are susceptible to the effects of oxygen starvation, regardless of physical endurance or acclimatization. If using sup-plemental oxygen, check the equipment and flow rate to ensure the symptoms are not hypoxia related.
These tubes are usually closed, but open during chewing, yawning, or swallowing to equalize pressure.
Kinesthesia refers to the sensation of position, movement, and tension per-ceived through the nerves, muscles, and tendons.
When these visual cues are taken away, as they are in instrument meteorological condi-tions (IMC), false sensations can cause a pilot to quickly become disoriented.
Symptoms of motion sickness include general discomfort, nausea, dizziness, paleness, sweating, and vomiting. If symptoms of motion sickness are experienced during a lesson, opening fresh air vents, focusing on objects outside the airplane, and avoiding unnecessary head move-ments may help alleviate some of the discomfort.
STRESS Stress is defined as the body’s response to physical and psychological demands placed upon it. If the airplane has a canopy or roof window, wearing light-colored, porous clothing and a hat will help pro-vide protection from the sun. The safe outcome of any flight depends on the ability to make the correct decisions and take the appropriate actions during routine occurrences, as well as abnormal situa-tions.
Any med-ication that depresses the nervous system, such as a sedative, tranquilizer, or antihistamine can make a pilot more susceptible to hypoxia. Although some people are allergic to certain analgesics or may suffer from stomach irrita-tion, flying usually is not restricted when taking these drugs.
The more a pilot under-stands about the eyes and how they function, the easier it is to use vision effectively and compensate for potential problems.
The retina con-tains light sensitive cells that convert light energy into electrical impulses that travel through nerves to the brain. Because of the relative darkness of the water, the lights along the shoreline can be mistaken for stars in the sky. Bright lights, steep surrounding terrain, and a wide run-way can produce the illusion of being too low, with a tendency to fly a higher-than-normal approach.
For example, a pure sine wave of 440 Hz corresponds to the note A on the fourth octave of the piano.
Swallowing and chewing actions open the tube to allow air in or out as needed for equalization. When the hair cells bend, they generate impulses that are carried by the 8th cranial nerve to the brain. Results showed that higher levels of noise actually helped to maintain performance on the tracking task over time. Other common pathological problems related to noise are cholesterol issues, gastric ulcers, sleep disturbances and mental stress. Figure 10 shows that at an early stage (Curve 1) speech is not affected and the person is still able to hear others speak. Since the nerves are all connected, pain on one organ can be felt on another part of the body. Dentists and doctors work hand-in-hand in finding the root cause of the pain and coming up with a treatment plan which considers the overall health and well-being of the patient. It is valid for 3 years for those individuals who have not reached the age of 40; otherwise it is valid for 2 years. Cold temperatures also can reduce circulation and decrease the blood supplied to extremities.
Research has shown that drinking one ounce of alcohol can equate to about an additional 2,000 feet of physiological altitude.
When flying at high altitudes, it is paramount that oxygen be used to avoid the effects of hypoxia. Common symptoms of hyperventilation include: Headache Decreased reaction time Impaired judgment Euphoria Visual impairment Drowsiness Lightheaded or dizzy sensation Tingling in fingers and toes Numbness Pale, clammy appearance Muscle spasms Hyperventilation may produce a pale, clammy appearance and muscle spasms compared to the cyanosis and limp muscles associated with hypoxia. Even a slight difference between external pressure and middle ear pressure can cause discomfort. Used in conjunction with visual and vestibular clues, these sensations can be fairly reliable. Although medications like Dramamine can prevent airsickness in passengers, they are not recommended while flying since they can cause drowsiness and other problems.
Aircraft heater vents and defrost vents may provide carbon monoxide a passageway into the cabin, particularly if the engine exhaust system has a leak or is damaged.
The body’s reaction to stress includes releasing chemical hormones (such as adrenaline) into the blood, and increasing metabolism to provide more energy to the muscles. Factors such as stress and prolonged performance of cognitive work can result in mental fatigue.
The influence of alcohol drastically reduces the chances of completing a flight without incident. The bloodstream absorbs about 80 to 90 percent of the alcohol in a drink within 30 minutes on an empty stomach.
However, flying is almost always precluded while using prescription analgesics, such as Darvon, Percodan, Demerol, and codeine since these drugs may cause side effects such as mental confusion, dizziness, headaches, nausea, and vision problems. Along with the loss of sharpness and color at night, depth perception and judgment of size may be lost. Often a set of regularly spaced lights along a road or highway can appear to be runway lights.
Equalizing air pressure ensures that the eardrum vibrates maximally when struck by sound waves. For the detection task, noise improved detection of the signals located in the center of the field of vision, but decreased detection performance when the signal was in the periphery.
In other words, as a person’s voice becomes louder than the background noise, the voice is more easily understood. A commercial pilot certificate requires at least a second-class medical certificate, which is valid for 1 year. The treatment for hyperventilation involves restoring the proper carbon dioxide level in the body. However, the body cannot distinguish between acceleration forces due to gravity and those resulting from maneuvering the aircraft, which can lead to sensory illusions and false impressions of the airplane’s orientation and movement. Chronic stress can be defined as a level of stress that presents an intolerable burden, exceeds the ability of an individual to cope, and causes individual performance to fall sharply. Even in small amounts, alcohol can impair judgment, decrease sense of responsibility, affect coordination, constrict visual field, diminish memory, reduce rea-soning power, and lower attention span. The body requires about 3 hours to rid itself of all the alcohol contained in one mixed drink or one beer.
The air pressure in the middle ear must be the same as the external atmospheric pressure in order for the eardrum to vibrate properly.
As PTS increases as depicted by Curves 2 and 3, the hearing loss affects speech intelligibility, and the person starts to be aware that there is an issue.
VHL is inherited in an autosomal dominant fashion, but two copies of the mutation are needed to cause the disorder. First-class med-ical certificates are required for airline transport pilots, and are valid for 6 months. As altitude increases above 10,000 feet, the symptoms of hypoxia increase in severity, and the time of useful consciousness rapidly decreases. Under normal flight conditions, when there is a visual reference to the horizon and ground, the sen-sory system in the inner ear helps to identify the pitch, roll, and yaw movements of the airplane.
However, carbon monoxide may be present in dangerous amounts even if no exhaust odor is detected. Unrelenting psychological pressures, such as loneliness, financial worries, and relationship or work problems can produce a cumulative level of stress that exceeds a person’s ability to cope with the situation. This makes the pattern of the opera-tion less smooth, because the pilot performs each component as though it were separate, instead of part of an integrated activity. As little as one ounce of alcohol can decrease the speed and strength of muscular reflexes, lessen the efficiency of eye movements while reading, and increase the fre-quency at which errors are committed. Most local anesthetics used for minor dental and outpatient procedures wear off within a relatively short period of time.
Walking from bright sunlight into a dark movie theater is an example of this dark adaptation period experience. Bright runway or approach light-ing systems can create the illusion that the airplane is closer to the runway, especially where few lights illuminate the surrounding terrain.
A second mutation can occur during a person's lifetime in a particular cell, which allows tumors and cysts to develop. Although the effects of the blood loss are slight at ground level, there are risks when flying during this time. In addition to slowing the breathing rate, breathing into a paper bag or talking aloud helps to overcome hyperventilation.
While the pressure of the air in the external ear canal increases, the middle ear cavity, which equalized with the lower pressure at altitude, is at lower pressure than the external ear canal.
Examples of stressors include physical stress (noise or vibration), physiological stress (fatigue), and psychological stress (difficult work or personal situations). Disruption of the perceptual field⎯ Concentrating attention upon movements or objects in the center of vision and neglecting those in the periphery.


Although a pilot may think that he or she is functioning normally, the impairment of motor and mental responses still remains.
The anesthetic itself may not limit flying so much as the actual procedure and subsequent pain. Cones are present throughout the retina, but are concentrated toward the center of the field of vision at the back of the retina. A pilot with a higher class medical certificate has met the requirements for the lower classes as well. Without visual refer-ences outside the airplane, there are many situations where combinations of normal motions and forces can create convincing illusions that are difficult to overcome.
In the presence of carbon monoxide, these detectors change color to alert the pilot of the presence of carbon monoxide. Pilots experiencing this level of stress are not safe and should not exercise their airman privileges.
Considerable amounts of alcohol can remain in the body for over 16 hours, so pilots should be cautious about flying too soon after drinking. Stimulants are drugs that excite the central nervous system and produce an increase in alertness and activ-ity. A bright light, however, can completely destroy night adaptation, leaving night vision severely compromised while the adaptation process is repeated. Since the class of medical required applies only when exercising the privileges of the pilot certificate for which it is required, a first-class medical would be valid for 1 year if exercising the privileges of a commercial certificate, and 2 or 3 years, as appropriate, for exercising the privileges of a private or recreational certificate. Box 25082 Oklahoma City, OK 73125 HYPERVENTILATION Hyperventilation occurs when an individual is experiencing emotional stress, fright, or pain, and the breathing rate and depth increase, although the carbon dioxide level in the blood is already at a reduced level.
This condition can be more difficult to relieve due to the fact that the partial vacuum tends to constrict the walls of the eustachian tube. In a classic example, a pilot may believe the airplane is in level flight, when, in reality, it is in a gradual turn.
Acute fatigue has many causes, but the following are among the most important for the pilot: Mild hypoxia (oxygen deficiency) Physical stress Psychological stress Depletion of physical energy resulting from psychological stress Sustained psychological stress accelerates the glandular secretions that prepare the body for quick reactions dur-ing an emergency. The result is an excessive loss of carbon dioxide from the body, which can lead to unconsciousness due to the respiratory system’s overriding mechanism to regain control of breathing.
To remedy this often painful condition, which also causes a temporary reduction in hearing sensitivity, pinch the nostrils shut, close the mouth and lips, and blow slowly and gently in the mouth and nose. If the airspeed increases, the pilot may experience a postural sensation of a level dive and pull back on the stick, which tightens the turn and creates increasing G-loads. Anytime a pilot smells exhaust odor, or any time that these symptoms are experienced, immedi-ate corrective actions should be taken.
These secretions make the circulatory and respiratory systems work harder, and the liver releases energy to provide the extra fuel needed for brain and muscle work.
When combined with altitude, the alcohol from two drinks may have the same effect as three or four drinks.
Common uses of these drugs include appetite suppression, fatigue reduction, and mood elevation. While the cones and their associated nerves are well suited to detecting fine detail and color in high light levels, the rods are better able to detect movement and provide vision in dim light. The standards for medical certification are contained in Title 14 of the Code of Federal Regulations (14 CFR) part 67, and the requirements for obtaining medical certificates are in 14 CFR part 61. These include turning off the heater, opening fresh air vents and win-dows, and using supplemental oxygen, if available. When this reserve energy supply is depleted, the body lapses into generalized and severe fatigue. Alcohol interferes with the brain’s ability to utilize oxygen, producing a form of histotoxic hypoxia. Some of these drugs may cause a stimulant reaction, even though this reaction is not their primary function. For 30 minutes before a night flight, avoid any bright light sources, such as head-lights, landing lights, strobe lights, or flashlights. It may not be possible to equalize the pressure in the ears if a pilot has a cold, an ear infec-tion, or sore throat. This is sometimes called the graveyard spiral, because if the pilot fails to recognize that the airplane is in a spiral and fails to return the airplane to wings-level flight, the airplane will eventually strike the ground. In some cases, stimulants can produce anxiety and mood swings, both of which are dangerous when flying. Pilots with disabilities may require special equipment installed in the airplane, such as hand controls for pilots with paraplegia. If the horizon becomes visible again, the pilot will have an oppor-tunity to return the airplane to straight-and-level flight, and continued visual contact with the horizon will allow the pilot to maintain straight-and-level flight. A well-balanced diet prevents the body from having to consume its own tissues as an energy source. In addition, the brain is a highly vas-cular organ that is immediately sensitive to changes in the blood’s composition.
There are so many cones in the fovea that the very center of the visual field hardly has any rods at all.
If experiencing minor congestion, nose drops or nasal sprays may reduce the chance of a painful ear blockage. However, if contact with the horizon is lost again, the inner ear may fool the pilot into thinking the airplane has started a bank in the other direction, causing the graveyard spiral to begin all over again. For a pilot, the lower oxygen availability at altitude, along with the lower capability of the brain to use what oxygen is there, adds up to a deadly combination. These drugs lower blood pressure, reduce mental processing, and slow motor and reaction responses.
So in low light, the middle of the visual field isn’t very sensitive, but farther from the fovea, the rods are more numerous and provide the major portion of night vision.
Red cockpit lighting also helps preserve night vision, but red light severely distorts some colors and completely washes out the color red.
Before using any medication, 15-4 check with an aviation medical examiner to ensure that it will not affect the ability to fly. Chronic fatigue, extending over a long period of time, usually has psychological roots, although an underlying disease is sometimes responsible.
There are several types of drugs that can cause a depressing effect on the body, including tranquilizers, motion sickness medication, some types of stomach med-ication, decongestants, and antihistamines.
The area where the optic nerve enters the eyeball has no rods or cones, leaving a blind spot in the field of vision.
Contact the local Flight Standards District Office (FSDO) for more information on this subject. In a similar way, air pressure in the sinuses equalizes with the pressure in the cockpit through small openings that connect the sinuses to the nasal passages. Unless a pilot has many hours of training in instrument flight, flight in reduced visibility or at night when the horizon is not visible should be avoided. ENVIRONMENTAL AND HEALTH FACTORS AFFECTING PILOT PERFORMANCE A number of health factors and physiological effects can be linked to flying.
An upper respiratory infection, such as a cold or sinusitis, or a nasal allergic condition can produce enough congestion around an opening to slow equalization. A pilot can reduce susceptibility to disorienting illusions through training and awareness, and learning to rely totally on flight instruments.
Chronic fatigue is not relieved by proper diet and adequate rest and sleep, and usually requires treatment by a physician. 14 CFR part 91 requires that blood alcohol level be less than .04 percent and that 8 hours pass between drinking alcohol and piloting an airplane.
Some drugs, which can neither be classified as stimu-lants nor depressants, have adverse effects on flying.
While flying at night, keep the instrument panel and inte-rior lights turned up no higher than necessary. Some are minor, while others are important enough to require special attention to ensure safety of flight. As the differ-ence in pressure between the sinus and the cockpit increases, congestion may plug the opening. Besides the sensory illusions due to misleading inputs to the vestibular system, a pilot may also encounter var-ious visual illusions during flight. An individual may experience this condition in the form of weakness, tiredness, palpitations of the heart, breath-lessness, headaches, or irritability. A pilot with a blood alcohol level of .04 percent or greater after 8 hours cannot fly until the blood alcohol falls below that amount. For example, some forms of antibiotics can produce dangerous side effects, such as balance disorders, hearing loss, nausea, and vomiting. Illusions rank among the most common factors cited as contributing to fatal airplane accidents.
Sometimes chronic fatigue even creates stomach or intestinal problems and generalized aches and pains throughout the body. Even though blood alcohol may be well below .04 percent, a pilot cannot fly sooner than 8 hours after drinking alcohol.
While many antibiotics are safe for use while flying, the infection requiring the antibiotic may prohibit flying. Focus the left eye on the X in the right side of the windshield and notice what happens to the airplane while slowly bringing the page closer to the eye. Some important medical factors that a pilot should be aware of include hypoxia, hyperventilation, middle ear and sinus problems, spatial disorientation, motion sickness, carbon monoxide poi-soning, stress and fatigue, dehydration, and heatstroke. Sloping cloud formations, an obscured horizon, a dark scene spread with ground lights and stars, and certain geometric patterns of ground light can create illusions of not being aligned correctly with the actual horizon. Although the regulations are quite specific, it is a good idea to be more conservative than the regulations.
In addi-tion, unless specifically prescribed by a physician, do not take more than one drug at a time, and never mix drugs with alcohol, because the effects are often unpredictable. Other subjects include the effects of alcohol and drugs, anxiety, and excess nitrogen in the blood after scuba diving. A sinus block can occur in the frontal sinuses, located above each eyebrow, or in the maxillary sinuses, located in each upper cheek.
Various surface features and atmospheric conditions encountered in landing can create illusions of being on the wrong approach path. Landing errors from these illusions can be prevented by anticipating them during approaches, inspecting unfamiliar airports before landing, using electronic glide slope or VASI systems when available, and maintaining proficiency in landing procedures. If fatigue occurs in the cockpit, no amount of training or experience can overcome the detrimental effects. Certain illegal drugs can have hallucinatory effects that occur days or weeks after the drug is taken.
Other factors, such as carbon monoxide poisoning, smoking, alcohol, certain drugs, and a lack of oxygen also can greatly decrease night vision. A narrower-than-usual runway can create the illusion that the airplane is higher than it actually is, while a wider-than-usual runway can have the opposite effect, causing the pilot to flare too high or overshoot the run-way. NIGHT VISUAL ILLUSIONS There are many different types of visual illusions that commonly occur at night.
Avoid flying without a full night’s rest, after working excessive hours, or after an especially exhausting or stressful day.
The Code of Federal Regulations prohibits pilots from performing crewmember duties while using any med-ication that affects the faculties in any way contrary to safety.
Sinus block can be avoided by not flying with an upper respiratory infection or nasal allergic condition.
Rain on the windshield can create the illusion of greater height, and haze can make distances appear greater than they are. The safest rule is not to fly as a crewmember while taking any medication, unless approved to do so by the FAA. Adequate protection is usually not provided by decon-gestant sprays or drops to reduce congestion around the sinus openings. DEHYDRATION AND HEATSTROKE Dehydration is the term given to a critical loss of water from the body.
If there is any doubt regarding the effects of any medication, consult an aviation medical exam-iner before flying. In some individuals, flashing lights at certain frequencies can trigger seizures, nausea, convulsions, or unconsciousness. The first noticeable effect of dehydration is fatigue, which in turn makes top physical and mental performance difficult, if not impossible.
SCUBA DIVING Scuba diving subjects the body to increased pressure, which allows more nitrogen to dissolve in body tissues and fluids. As a pilot, flying for long periods in hot summer temperatures or at high altitudes increases the susceptibility of dehydration since the dry air at altitude tends to increase the rate of water loss from the body.
The reduction of atmospheric pressure that accompanies flying can produce physical problems for scuba divers. If this fluid is not replaced, fatigue pro-gresses to dizziness, weakness, nausea, tingling of hands and feet, abdominal cramps, and extreme thirst.
Reducing the pressure too quickly allows small bubbles of nitrogen to form inside the body as the gas comes out of solution.
The bends can be experienced from as low as 8,000 feet MSL, with increasing severity as altitude increases. As noted in the Aeronautical Information Manual (AIM), the minimum recommended time between scuba diving on nondecompression stop dives and flying is 12 hours, while the minimum time recom-mended between decompression stop diving and flying is 24 hours.




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