Nicotine Effects on Vestibular Function in Pilot Selection

An optimal spatial orientation is essential for pilots. Therefore, pilot applicants in the Royal Danish Air Force undergo various ear-nose-throat evaluations. It is recommended to avoid alcohol for a minimum of 24 h before evaluation. No recommendation has been made regarding nicotine and, with the increasing availability of nicotine through pouches and other products, it is therefore relevant to examine its impact on vestibular function, particularly on nystagmus, which plays a key role in clinical vestibular assessment.

We conducted a structured literature search using PubMed and Cochrane Library as the primary databases in 2025 and 2026. The search strategy used a combination of keywords and MeSH terms and criteria for inclusion and exclusion were made.

In total, 22 studies were included looking at nicotine's effect on the vestibular system. Overall, the studies showed an impact on the vestibular system and the induction of nystagmus through different delivery methods of nicotine. The effects of nicotine on nystagmus appear within minutes and can persist for up to 30 min, and nicotine blood concentrations are measurable more than 2 h after exposure.

We suggest that pilot applicants be advised to abstain from nicotine products for a specified period of 12-24 h before undergoing ear-nose-throat examinations to minimize test interference. Further studies are needed to uncover the effect nicotine can have on in-flight performance. Kahlhofen N, Lindgaard K. Nicotine effects on vestibular function in pilot selection. Aerosp Med Hum Perform. 2026; 97(8):638-643.