Ear, Nose, and Throat Disorders

Miscellaneous Otic Conditions

Otitis Media

• Restrictions for acute otitis media should be rarely needed.
• Restriction may be required
  • if medications are used which are sedating (pain medications, antihistamines, etc.)
  • if significant hearing loss is present
• Chronic otitis media can lead to impaired hearing (see Hearing chapter for evaluation of permanent hearing loss).

Perforated Tympanic Membrane (PTM)

• In most cases restrictions will not be necessary and spontaneous healing should occur within 2 months.
• If healing is delayed, surgery to repair the TM may be indicated.
  • Following surgical repair, or where perforations involve the pars flacida or the annulus of the TM, periodic evaluation for development of complications such as cholesteatoma would be indicated.1
• In more complicated cases where damage to the middle or inner ear is suspected or present (head trauma, acoustic trauma, penetrating foreign body, etc.), formal clearance from the treating ENT provider, as well as evaluation/clearance for any persistent hearing loss or balance disturbance is indicated.
• If balance disturbance is present, the LEO can return to full duty when:
  • Symptoms have resolved
  • Off all anti-vertigo medications
  • No signs of any persistent vertigo
    – normal Romberg
    – no nystagmus)
  • If there is persistent vertigo, ENT evaluation and/or electronystagmography may be considered to assist with the return-to-duty decision
• For LEOs who require clearance for respiratory protection (e.g., SWAT team members, clandestine drug lab teams, etc.), it should be remembered that a PTM can potentially allow respiratory hazards to enter the respiratory tree via the Eustachian tube, thereby bypassing the respirator. It is the consensus of the Task Group that LEOs working in potential dangerous chemical environment wear a flanged earplug until the PTM is healed.2 (See Appendix A for detailed discussion.)

Cholesteatoma

Restrictions depend on the symptoms present. Hearing loss is common and permanent and should be evaluated according to the LEO Hearing chapter guidance.3,4

If balance disturbance is present, restrictions will depend on the severity and stability of the symptoms. The LEO can return to full duty when:

• Symptoms have resolved
• Off all anti-vertigo medications
• No signs of any persistent vertigo
  • normal Romberg
  • no nystagmus
• If there is persistent vertigo, ENT evaluation and/or electronystagmography may be considered to assist with the return-to-duty decision.