How to Manage Ear Troubles

Even with a sound understanding of how pressure affects divers’ ears and practical knowledge of equalization techniques, divers still experience ear problems. Here are a few of the most common and some tips for avoiding and managing them.

Middle-Ear Barotrauma

Middle-ear barotrauma (MEBT) is the most common dive injury. It occurs when pressure in the air space of the middle ear is not equalized to the ambient pressure. This can happen while flying or diving and can lead to ruptured ear drums.

The Eustachian tube connects the throat to the middle ear and enables pressure equalization. When there is an obstruction in the Eustachian tube, equalization is not possible. If the pressure in the middle ear is lower than the pressure of the surrounding tissue, there is negative pressure in the middle-ear space. The tissues swell, the eardrum bulges inward, and fluid may begin to leak from the tissues. 

If a diver is having problems equalizing, middle-ear pressure during descent will first feel like clogged or stuffed ears and could progress to severe pain. Further descent will increase the pain. Other symptoms may include fluid buildup, bleeding and eardrum rupture — which could lead to hearing loss or vertigo.

MEBT can be prevented through proper equalization and avoidance of diving while congested. If you feel pain with repeated attempts to descend, abort the dive.

Alternobaric Vertigo

When the two ears are equalized differently, alternobaric vertigo may result.

First documented in 1965, alternobaric vertigo is caused by unequal pressurization of the two middle ears, which causes the brain to perceive the difference as movement. Beyond the vertigo, additional symptoms may include ringing in the ears and fullness or muffled hearing in one or both ears. Nausea and vomiting can occur in severe cases, as can involuntary movement of the eyes. Symptoms persisting more than a few minutes may indicate a more serious condition.

While alternobaric vertigo can happen during descent or ascent, it is most commonly associated with ascent. Simple ways to reduce the likelihood of alternobaric include proper equalization and not diving while congested.

If you experience symptoms of alternobaric vertigo happen to you underwater, first stay calm. Then, focus on a fixed point until the symptoms subside. If symptoms occur at the beginning of the dive, abort the dive. If you experience symptoms later in the dive, end the dive safely. As necessary, enlist your buddy’s help with a controlled ascent.

Swimmer’s Ear

When ears are exposed to water and warm conditions for too long, inflammation and infection can arise in the ear canal, resulting in swimmer’s ear (otitis externa). The protective barriers lining the ear canal can weaken, resulting in pain or discharge. Water can enter the tissues lining the ear canal, creating opportunity for bacteria normally found on the surface of the ear canal to penetrate the skin and find an environment conducive to elevated growth. Swimmer’s ear is more likely to develop if the skin is already chafed.

Symptoms include itchy ears, pain, tenderness and swelling of the ear canal. If untreated, swelling can infiltrate nearby lymph nodes and create enough pain that moving the jaw is uncomfortable.

If you suspect swimmer’s ear, stop diving or swimming and schedule an appointment with a doctor. A not-too-hot hair dryer can be used to carefully dry the ears after a shower, and over-the-counter medications can help ease any associated pain. Prevention is often as simple as rinsing your ears with fresh water after diving or simply keeping them clean and dry. If you experience recurring swimmer’s ear, you may be able to prevent it by rinsing your ears with a 1:1 mixture of vinegar and isopropyl alcohol after your last dive of the day.

As your ears are used for so much more than just hearing, how you manage them while diving is incredibly important. Learn and practice various ear equalization techniques, and practice good aural hygiene. And if at any point during your dive you can’t equalize, abort. Listen to your body, and you’ll enjoy many years of diving — and healthy ears.