Ear pain diving: Ear Pain & Diving: Why Your Ears Hurt Underwater

31.10.202007.06.2023 by alexxlab

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Ear Pain & Diving: Why Your Ears Hurt Underwater

Did you ever swim to the bottom of a pool and suddenly your ears were killing you? What you experienced was one of the most common problems associated with diving: Ear pain caused by a significant increase in water pressure. We’ll take a close look at why your ears hurt and what you can do about it.

Scuba divers are constantly exposed to this phenomenon. So much so, that the diving community named it the “ear squeeze”. As divers descend down towards the bottom of the sea, the water pressure on their eardrums increases. This pressure against the eardrums causes the symptoms of ear squeeze.

Starting with a feeling of fullness, it can become quickly very uncomfortable and dangerous as the eardrums swell and bulge. If the pressure continues to increase, the eardrums may burst. As a result, freezing cold seawater rushes into the middle ear, causing nausea, dizziness and vomiting. A less than ideal situation for a diver many meters below the surface of the water.

Since scuba divers usually go far below the normal depth of a public pool, there must be a solution to this kind of ear pain. Should you ever be diving and experiencing ear pain, it is very important not to ignore it.

You need to know how to clear your ears and when to abort the dive to prevent injuries and permanent damage to your ears. So let’s dive right in.

Why do your ears hurt when you’re diving?

As you dive deeper underwater, environmental pressure increases drastically. It’s why submarines have to be highly pressurised to prevent them from being crushed as they dive far below the surface. Your ears are similar in that way.

Normally, the pressure inside and outside of the ear is the same. Then, everything is fine and you’re probably not giving it another thought.

But when you dive, there is water on the outside of your ear, and air on the inside of your ear – the middle ear to be exact (the middle ear is the area behind the eardrum).

Your body can counterbalance this pressure, but for this to happen, the air pressure must reach the inner surface of the eardrum. And that is a job for the eustachian tube.

The eustachian tube links the ears to the nose and throat and opens and closes to regulate the middle ear pressure. If the eustachian tube is not functioning correctly, you’ll feel the “ear squeeze”.

Ear injuries from diving are completely preventable. In order to stay safe, you need to learn how to equalise the pressure in your ears BEFORE you start diving.

You might recognise this phenomenon from elsewhere. If you’ve ever been on an aeroplane, you’ve probably felt it in your ears before. When the plane takes off or lands, the air pressure around you changes. Oftentimes people recommend chewing gum during a flight and they’re not wrong. The movement of your jaw can possibly open up the eustachian tube, helping your ears to equalise the pressure.

What can make ear pain worse?

Anything that may affect the functionality of the eustachian tube will make ear pain more likely whilst scuba diving. Even the common cold can greatly affect the performance of the eustachian tube, along with other respiratory problems and chronic sinus conditions. Allergy suffers, including those with hay fever are at risk, too. So are smokers and other individuals with pre-existing conditions, such as nasal polyps or previous facial trauma.

Note: Prospective scuba divers who are suffering from a respiratory illness or significant nasal/sinus problems should be discouraged from diving by their instructor.

Ear pain from diving: Knowing the risks

One of the major risks associated with ear pain whilst scuba diving is the potential to perforate the eardrum. A very simple rule can be applied here if you are experiencing ear pain whilst descending underwater: Stop your descent and try to equalise. If you are unable to equalise, the dive must be aborted and you should return to the surface.

If you are unable to equalise and relieve the ear pain and continue your descent, you are at a very high risk of perforating your eardrum, which carries the added risks of disorientation, dizziness and nausea – not something you want whilst you are deep underwater.

Once an eardrum has been perforated it may never fully return to normal, so you may be left with recurrent problems preventing you from diving in the future.

Treatment forms for ear pain from scuba diving

Ear pain through scuba diving is usually temporary, and will likely disappear on its own, usually within a few days. If this pain persists, we do recommend that you seek medical intervention.

Should the eardrum be perforated, it normally heals naturally, without medical intervention. But it is important to keep the ear dry during the healing process or be at risk of middle ear infections.

If you choose to seek medical attention following the scuba dive, the physician will likely initially ask a series of questions regarding the dive itself, alongside medical history questions regarding previous sinus problems and respiratory illnesses.

They will then examine the ear thoroughly using an otoscope, in order to assess the health of the eardrum. They will look for any perforations, and look to see if the eardrum is ‘bulging’, or retracted, which can be signs of eustachian tube dysfunction.

Hearing loss is another concern with perforated eardrums, which will need to be monitored regularly. The physician may decide to refer you onwards to an Audiologist, where further testing, including a middle ear function test, called a tympanogram can be performed to provide more information about the health of the middle ear.

How to prevent permanent ear damage from diving

As discussed earlier, the primary preventative measure is to abort the dive at the first sign of ear pain which is not relieved through decompression. It is important to complete all of the recommended decompression stops as you descend; these are in place for this exact reason.

If you are prone to sinus congestion and allergy-related problems, then your physician may recommend oral or nasal decongestants, along with antihistamines where allergies are involved.

Should you proceed with the dive whilst experiencing ear pain and suffer a perforated eardrum, then a course of antibiotics will be required to prevent infection, along with a trip to the Audiologist to have a hearing test.

In some cases, surgery may be required if the perforation is too large to heal naturally. You will likely need to also stock up on paracetamol as eardrum perforations are painful.

Ear Injuries And Diving: Key Takeaways

Ear pain through scuba diving is common and is caused by the difference in pressure in the middle ear compared to the external pressure as you descend in the dive.
Equalising at your decompression stops will usually prevent this pain, but in some circumstances, equalising may not be possible.
This is usually caused by eustachian tube dysfunction, which is linked to sinus problems associated with upper respiratory problems and allergies.
If you have a cold or sinus congestion, seek medical advice prior to diving and consider taking decongestants or antihistamines in the lead up to the dive. You may want to reconsider your decision to dive if the symptoms persist.
Should you experience ear pain during the dive and are unable to equalise, it is important to halt your descent and potentially abort the dive, as continuing your descent can lead to further problems such as perforating the eardrum, dizziness, disorientation and nausea.
Seek medical advice should ear pain continue longer than a week after your dive.

If you’re suffering from ear pain from diving, a ruptured eardrum or have any other concerns around your hearing health, call your nearest Attune clinic today and get a thorough diagnosis of your ears by one of our friendly, qualified Audiologists.

Ear Pain When Diving – What Causes It And How to Stop It!

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Do you experience ear pain when diving? If so, congratulations – you have one of the most commonly reported (and most unwelcome) side effects of diving incorrectly. However, did you know that you should not experience ANY ear pain when diving?

Find out why people experience ear pain when diving, and what steps they need to take to be able to dive pain free.

What Are the Causes of Ear Pain When Diving?

There is no single cause for ear pain when diving, but a checklist of possible causes is always worth working through so that you can get to the root cause. The most common causes of ear pain when diving are:

Infection
Foreign object
Existing Injury
Pre-existing ear condition
Some medications
New injury causing the resulting pain
Illness such as a cold, sore throat
Diving soon after flying
Lifestyle factors such as diet, smoking, allergies etc
Inadequate equalisation or ‘ear squeeze’

This list is not exhaustive. However, if you have been able to rule out most of these possible causes, what you are most likely left with is diet and equalisation.

Ear Pain When Diving can come in many different forms and present a number of different associated symptoms:

Centralised ear pain
Discharge from facial orifices
Fullness in the ear
Temporary or permanent hearing loss
Tinnitus
Nausea
Vomiting
Vertigo

What Should You Do If You Experience Ear Pain When Diving?

Pushing through the pain should not be an option you even consider. The pain is there for a reason indicating something is not right. Continuing to dive or descend will at the very least become increasingly difficult – and painful, but you significantly increase the chances of causing temporary or permanent ear damage. For some, this could even signal the end of diving, full stop.

What Injuries May Occur As A Result Of Ear Pain When Diving?

If you are unlucky enough to suffer an injury to your ear when diving, the most likely injury is a perforated ear drum. This most often occurs during descent, but can also occur during ascent and is caused by ineffective equalisation causing an increased pressure to perforate the eardrum. If it happens on the way up it is due to reverse block with the eardrum perforating or rupturing outwards. More on reverse block below!

If a perforated (or ruptured) eardrum is not the cause, another possibility is severe middle ear barotrauma, which can be equally painful.

What Can You Do To Reduce The Chances Of Ear Pain When Diving?

To reduce the chances of ear pain, you first have to understand where the cause of the pain originates as these are two completely different things. Ear pain when diving most often occurs as a result of the health and condition of the Eustachian tube in our ears

How Do I Equalise My Ears?

When we talk about equalizing the ears, we mean equalizing the middle ear. This is the area behind the eardrum that leads, via the Eustachian tubes, to the back of the throat.

Most people experience the need to equalize this air space when they are on a plane that is taking off or landing, or in a car going down a steep hill. You get a feeling of pressure in your ears, which can be relieved by chewing, swallowing, yawning or moving your jaw. These pressure changes are slow compared to the ones experienced during a freedive, particularly in the first ten meters, and so most people need to use a more powerful equalization technique.

An interesting experiment to see how easily your Eustachian tubes can open is the hum test. You hum and, whilst humming, move your jaw strongly forward. If the hum gets louder inside your head, on the left or right side or both, then you have opened your Eustachian tubes. If this is tricky then you can try pushing the jaw forward and to the left to open up the right side and to the right for the left side. I have always found it difficult to equalize my ears, particularly the right one. When I do the hum test, only occasionally I can open up my left Eustachian tube, but never the right.

The best way to equalise is to master the Frenzel Technique, which uses the back of your tongue to create pressure in the back of your throat, equalizing your ears while keeping your epiglottis shut.

Here is my article and video, which may help explain further:

I Still Can’t Equalise!

There are many issues that people can have with equalization for freediving. Here are some of the most common:

Failure to equalize frequently enough – In the first 10 meters below the surface, the pressure doubles and you need to frequently equalize.
Equalizing too late – Preempt every equalization. If you feel strong pressure or pain in your ears then you have left equalizing too late and it may become impossible to equalize.
Equalizing only one ear – Make sure you have equalized both ears. If you have a ‘good’ ear and a ‘bad’ ear, it sometimes means that you equalize only one but think that you have equalized both.
Do not strain – Equalize gently but effectively. You do not want to strain when equalizing, as this can over-pressurize your ears (in extreme cases blowing them outwards) and can cause reverse block.
Unable to equalize – If you cannot equalize, stop and come back to the surface. You want to avoid damaging your ears at all costs.
Cannot equalize head first – Pulling feet first down the line can be very helpful in learning how to equalize. It is much easier to equalise feet first than head first.

What is the difference between Ear Squeeze and Reverse Block?

Ear squeeze is caused when you descend and is a result of increased pressure on your middle ear causing pain and potential injury. As you descend, the air spaces in our body become smaller and we need to add air into them to return the pressure to normal. As the air space in the middle ear gets smaller, the eardrum is pulled inwards, causing first pressure and then pain. You open up the eustacian tubes so that air can move via the back of your throat into the middle ear, returning the ear drum to its original position.

Reverse block is a serious situation to find yourself in. It means that the tissues have become so congested around your Eustachian tubes that, as you ascend from a dive, they squeeze around the eustachian tube, preventing it from opening. The expanding air inside your middle ear then cannot escape down the back of your throat. As a result, your eardrums bend outwards, and if the pressure is not released then your eardrum will rupture.

If this happens, immediately stop your ascent and hold onto the dive line. Wiggle your jaw and move it forwards as with the hum test above. Do not pinch your nose and try to equalize as this will compound the problem. Ascend as slowly as you can, moving your jaw as you go. If this doesn’t work and you are running out of air, then come straight to the surface, as it is better to have a problem at the surface than at depth.

Ways to Improve Equalization

Here are a number of ways you can help improve your equalisation:

Stretch the area around your Eustachian tubes
Use a neti-pot and steam inhalation sessions to cleanse your sinuses.
When flying, cover your nose and mouth with a layer of fabric or a mask to help you breathe humid and filtered air
Use Docs Pro plugs.
Make sure your ears are free of wax.
Use a silicone barrier in your ears to prevent infection.
Use an Otovent Dive to help open up the eustachian tubes and practice equalisation.
Visit a cranial osteopath to see if there is an congestion in the skill that they can relieve.
Keep hydrated.
Keep as relaxed as possible when you dive, keep the chin tucked in and preempt every equalisation

What About The Future?

It is true to say that for some, their ability to dive may end as a result of the barotrauma injuries they sustain. However, for most, with practice, a change of diet and a careful reintroduction to diving, a return to diving is usual.

Want to learn about mask squeeze?

Visit our blog here!

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Complete Ears of Problems – PADI Pros

Staff Contributors DAN

Ear injuries account for the vast majority of divers’ medical problems. This is understandable as we all put them under stress when diving, and this is especially true for professionals who go deep, come up and out of the water all day long.

Your ears experience 10 percent more pressure on the first meter of descent than on the surface. At a depth of two meters, this pressure doubles, and at four meters it is enough to rupture eardrums, damage blood vessels, and draw fluid into the inner ear. Despite this, many divers equalize their ears too late or forget to do so in an attempt to keep up with others on their descent.

Ear injuries can happen quickly and without warning, but by firmly establishing the importance of leveling early and continuing this procedure throughout the dive while still learning, you can help your student divers stay out of trouble. Let’s look at the most common ear injuries so you can give your students ears full of useful information.

Tympanic membrane

Rupture of the tympanic membrane or tympanic membrane is usually the result of the diver not equalizing pressure in the middle ear or blowing too hard (performing the Valsalva maneuver). The condition is often accompanied by pain, although a tear can ease the feeling of pressure on the ear. This may be accompanied by dizziness. Most tears heal within a few weeks, although surgery may be required in some cases. Factors such as a runny nose, insufficient training, and excessive descent speed can increase a diver’s risk of eardrum rupture.

Inner ear barotrauma

Like a tympanic membrane rupture, inner ear barotrauma can be caused by the diver not equalizing the pressure or performing a too abrupt Valsalva maneuver. A significant pressure difference between the outer and middle ear can cause the round window to bulge outward, which can lead to injury to the inner ear without tearing. If the round window is ruptured, fluid loss in the inner ear can damage hearing and balance, and surgery may be required. Divers with inner ear barotrauma often experience severe dizziness, hearing loss, tinnitus, a feeling of fullness in the ear, and involuntary eye movements known as nystagmus.

Middle ear barotrauma

Middle ear barotrauma is a condition in which the pressure in the tympanic cavity (the air-filled space in the middle ear) is significantly lower than the pressure outside the ear, resulting in a relative vacuum that causes the eardrum to bulge inward , and the tissues of the ear swell, and the fluid and blood from the ruptured vessels seeps into the tympanic cavity. This may be caused by failure to equalize pressure or blockage of the Eustachian tubes during descent. Divers with middle ear barotrauma typically report initial discomfort, which can worsen, causing severe pain and a feeling of clogged or blocked ears.

Facial baroparesis

Facial baroparesis is a reversible paralysis of the facial nerve due to increased pressure in the middle ear, which in some people can stop the circulation of impulses to the facial nerve close to the ear. This can happen during a flight or dive, and symptoms typically include numbness, tingling, weakness, and facial paralysis. Sometimes there may be sagging of the muscles of the face, which causes concern, but baroparesis in the face often resolves without medical intervention. Divers who exhibit symptoms of facial baroparesis should seek medical attention to rule out the possibility of other serious illnesses.

Barotrauma of the middle ear – Diving in the Andaman Sea

Barotrauma. According to statistics, every second diver in the world deals with this disaster.

What is it?

Middle ear barotrauma is the accumulation of fluid in the middle ear or damage to the eardrum. Damage can be of varying degrees, up to rupture. In the case of divers, barotrauma occurs due to unfavorable equalization of pressure in the air space of the middle ear during diving.

How does it work?

There is a closed air pocket in the middle ear. The pressure there in the normal state is balanced with the pressure of the environment. The Eustachian tube, located between the nasopharynx and the ear, is responsible for this. It provides air movement when pressure equalization is necessary.

Leveling usually occurs with little or no effort. This action can make swallowing or yawning easier. Car just in order to facilitate the process of pressure equalization, they are handing out sweets on the plane.
Obstruction, or simply swelling, in the Eustachian tube can make it impossible to equalize pressure, especially during descent when the pressure changes quite quickly.

Now let’s analyze in detail the unpleasant process of barotrauma.

When middle ear pressure is lower than ambient pressure, an imbalance occurs. This misalignment results in a vacuum in the middle ear. Which in turn contributes to tissue edema and the eardrum is pulled inward. At this time, bleeding occurs from the superficial vessels. When the Eustachian tube is blocked, trying to equalize the pressure will not lead to anything. On the contrary, the increased blowing according to the Valsalva method can cause significant damage. We will teach you how to blow correctly in the first lesson.

How does this manifest itself on the physical level?

First, there is discomfort in the ears, which can grow to a noticeable pain.
Further immersion only increases the pain in the ears. And then there is serous fluid and bleeding in the middle ear. If the dive continues, the eardrum will rupture. This will cause short-term pain relief. However, the penetration of water into the middle ear can cause dizziness, hearing loss and infection.

What can I do to prevent barotrauma?

- If you experience discomfort in your ears during the descent, stop the descent. Try to blow out and equalize the pressure.
- You can go up half a meter to a meter, this will facilitate pressure equalization.
- If the pressure cannot be equalized, stop the dive immediately. It is better to skip one dive than to treat the consequences for a long time and not dive for a long period.

Factors favoring the occurrence of barotrauma:

- cold
- allergy
- inflammatory processes in the nasopharynx
- incorrect blowing
- too fast descent or ascent

Barotrauma First Aid:

- For stuffy ears after diving, refrain from further diving.
- Use a vasoconstrictive nasal spray or drops. This will reduce swelling of the nasal mucosa and Eustachian tubes
- Do not put drops in the ear.

Treatment of barotrauma:

- Seek medical attention, especially if ear pain and congestion lasts more than three hours.
- Dizziness can also be a symptom of inner ear barotrauma.
- Severe dizziness and nausea after diving is a medical emergency.