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.

Background: A 41-year-old test pilot from the fighter stream presented to the Institute of Aerospace Medicine (IAM) with carcinoma lower one-third of rectum (opted) and a history of 2 years of follow-up post-surgery. He was physically fit with a healthy stoma in the left iliac fossa region. There was no history of local recurrence or distance metastases of colorectal cancer (CRC). During his evaluation at IAM, the officer had completed the OPTRAM profile with a stomal guard in place and could do AGSM effectively. Considering the overall prognosis, which was found to be favorable, the pilot was recommended an upgradation to a restricted flying category in the type, subject to a 1 time waiver from Director General Medical Services (air). Discussion: According to the Indian Council of Medical Research consensus document for the management of CRC 2014, the annual incidence rate of colon cancer and rectal cancer in Indian male population is 4.4 and 4.1/100,000, respectively. Surgery is the primary treatment for such cancers and they are mostly curative. Multimodal therapy with neoadjuvant chemotherapy and radiotherapy is done to improve the survival rates. Latest reports published by the National Comprehensive Cancer Network for Rectal Cancer, Version 2.2018, Clinical Practice Guidelines in Oncology indicate that the peak mortality rates are currently down by 50% due to better treatment modalities. Depending on the site of primary tumor, the surgery might leave the patient with either a temporary or a permanent colostomy wound. Conclusion: There was no available record/published case report of any pilot being returned to the cockpit in military flying with a permanent stoma. This case was a first of its kind with respect to aeromedical decisionmaking. With mortality rates decreasing due to effective treatment for cancer, aeromedical decision in more such cases may be required in the future. This case will serve as a precedence in effectively returning trained aviators to the cockpit.

Introduction: During space missions, crew is encountered with various psychological challenges. One major challenge during space mission is the issue of isolation and confinement. Understanding of human behavior and performance in isolated and confined environment (ICE) has been the area of interest for all those involved in human space program. Ground-based mission-specific studies are necessary before undertaking any specific mission so that the psychological impact of ICE can be investigated in details. The first human space flight of India, which may be launched in the near future, may involve for a duration not more than 24 h. This scientific experiment was undertaken with an aim to study the impact of 24 h isolation and confinement on psychological state of healthy human volunteers. Material and Methods: During 24 h period of isolation and confinement, 10 healthy human volunteers were evaluated every 10–12 h with State-Trait Anxiety Inventory, Positive and Negative Affect State (PANAS), and Profile of Mood States (POMS) in the existing Isolation cum Group Confinement laboratory of Institute of Aerospace Medicne (IAM). Similar psychological evaluation was also carried out among nine healthy individuals who served as controls. Results: There was a momentary increase in state anxiety level during early period of isolation and confinement exposure (ICE). However, the anxiety level returned to pre-exposure level after 24 h. Furthermore, there was a significant drop in the level of negative emotions among the subject group as well as among control group in the morning of day 2 though there was no significant change in the positive emotions. Over the period of 24 h of isolation and confinement, neither the subject group nor the control group showed statistically significant changes in the total mood disturbance. None of the groups showed any significant changes in any of the POMS subscales, that is, anger-hostility, confusion-bewilderment, depression-dejection, fatigue-inertia, and tension-anxiety except for vigor-activity. Thus, a stable mood state was observed among the participants. Conclusion: Before exposure to isolation and confinement, the subject group exhibited a higher level of “State” anxiety on day 1 which had returned to pre-exposure level in the morning of day 2. In both days, the state of positive emotions was statistically insignificant among subject as well as among control group. However, a significant decrease in the level of negative emotions among the subject group and control group was observed. There was no significant change in the mood state in the study group as well as in the control group.

Introduction: Head-up tilt (HUT) testing is a widely accepted tool in the clinical evaluation of patients presenting with episodic loss of consciousness. The test has assumed its importance in aviation environment, where a single episode of unconsciousness in-flight may have a catastrophic outcome. To rule out this, HUT is carried out in all cases of syncope as a part of aeromedical evaluation. The present study was undertaken to analyze the CVS response to HUT conducted over a period of 11 years at the Department of Space and Environmental Physiology at the Institute of Aerospace Medicine. Material and Methods: A total of 168 subjects had undergone HUT testing from 2002 to 2012. The testing equipment was a standard tilt table with a foot board support for the feet and restraint system at the level of chest, waist, and ankle to support the body during tilting. The testing protocol consisted of passive tilting to an angle of 70° from the horizontal position for 45 min in all the cases. The physiological parameters consisting of heart rate (HR) and blood pressure from the database were analyzed to understand the CVS response to HUT. Results: Out of the total 168 patients, 147 (88.5%) cases showed normal response. Twenty-one (12.5%) cases showed abnormal response. Out of the cases showing abnormal response, 14 cases had syncope with frank loss of consciousness and could not maintain the postural tone. The remaining seven cases showed postural orthostatic tachycardia syndrome (POTS), where the HR increased by more than 30 beats per minute. Conclusion: A retrospective analysis of 168 cases with history of syncope, in a period of 11 years, revealed an abnormal cardiovascular response to HUT in 12.5% of cases. The abnormal physiological responses were mostly consistent with syncope and POTS.