During the operation of an aircraft, disorders of equilibrium may interfere with the capacity of aircrew members to control the aircraft in either of two ways: through the abrupt occurrence or recurrence of episodic dizziness or disequilibrium in an individual who is normal at other times,1 or through a continuous state of disequilibrium without episodic changes. In either case, dizziness or disequilibrium may prevent accurate control of the aircraft during maneuvers requiring a high degree of perceptual accuracy, such as takeoff, landing, in-flight attitudinal changes, instrument flight, etc. The considerations for evaluation of aircrew fitness, the predictability of incapacitation, and the consequences of each type of disequilibrium on aircraft control may be quite different.2
Entry of aircrew members into a disequilibrium protocol may occur under several circumstances. Complaints of dizziness, vertigo, or light-headedness, complaints of loss of balance, or observations by others of episodic or persistent impairment of
Drachman DA, Apfelbaum RI, Posner JB. Dizziness and Disorders of Equilibrium—Panel 8. Arch Neurol. 1979;36(12):806–810. doi:10.1001/archneur.1979.00500480080010
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