Ear problems are one of the most common and annoying issues for many divers.
Equalization problems can affect everyone, no matter the level of experience. It can be painful, stressful, it can ruin your dive and sometimes it can even keep a diver from coming back to the water.
Let’s start at the beginning. We all know that when we descend, the pressure inside the air spaces of our body increases. Pressure has no effects on liquids and 90% of the human body is liquid so we just have to take care of the air spaces. These are lungs, sinuses and ears.
What happens to my ears when I equalize?
Our ears have mainly 3 parts: outer ear, middle ear and inner ear. When we go diving, our outer ear gets full with water so it doesn’t cause us any problems. Our inner ear is full with ear liquids so usually is not a problem either. However, our middle ear is a dead air space and when the pressure increases, this change creates discomfort in our eardrum and in our inner ear soft tissues.
How can we avoid this discomfort?
Our middle ear is connected to our nose by the Eustachian tubes. We just have to add air as we descend to compensate for the pressure change.
The most common way to do this, is by pinching your nose and gently blowing air against your pinched nostrils. We should hear/feel a “pop” in our ears, relieving the discomfort and indicating that all is good. This is known as the “Valsavia manoeuvre”.
An alternative, can be to pinch your nose at the same time that you swallow. You can also try moving your jaws side to side or to mimic the yawning motion. These techniques use the throat muscles to open the Eustachian tubes instead of the air pressure exhaled through your nose of the Valsavia manoeuvre.
What problems can we face while diving?
All this theory sounds very good. But in practice, it doesn’t always work. Sometimes when we go diving, our ears (one of them or both), dont want to equalize. Below we describe several reasons:
This is the most common cause. If you are going through a cold, is very likely that your tubes are blocked by the excess of mucus, making very difficult or even impossible the process of equalization. In this case, if you have tried gentle and often and is still not working, our advice is to cancel the dive until you recover from your cold and the blockage disappears by itself.
We don’t encourage the use of decongestants as is possible that the effect of the medication disappears while diving at depth and you may suffer a reverse block. A reverse block occurs when expanding air is trapped inside a diver’s air spaces as he ascends to the surface and it can be very painful. The pain in this case, is caused by too much air in the middle ear, rather than too little.
Reverse blocks are rare but rather dangerous; the diver cannot ascend as it’s very painful but obviously he has a limited amount of air and time underwater. In this scenario, the diver must descend and try to ascend again, very slowly.
You can read an example in https://www.diversalertnetwork.org/diving-incidents/An-assistant-instructor-suffers-a-reverse-block
Our recommendation will be: if you have a cold and you cannot equalize, cancel the dive. Dont worry, the ocean will be still there next time.
–Excesive ear wax
During the dive the excess of wax in the outer ear is pushed in towards the eardrum, putting pressure in it. This extra pressure can stop the ears from properly equalizing. Hold on! This doesn’t mean that you should run to stick a cotton bud into your ears. Most of the times you will just push the wax deeper and you may damage your eardrum. Best thing to do is to ask our doctor. Wax is a natural protection for your ears and you should ask your doctor how and when to remove it.
–Patulous Eustachian Tube (PET)
This is the name of a rare disorder where the Eustachian tube doesn’t close and stays intermittently open. Other eustaquian tube conditions, as having an anormally narrow tube, can also give problems while diving. These conditions must be diagnosed and treated by an specialist.
Other ear problems can be sinusitis, nasal polyps or ear infections. A doctor should also diagnose and treat all of those.
Tips and advice
- Check that you dont have a cold or congestion before diving.
- Descent slowly and in a control manner. Use a descend line if your buoyancy is not good enough
- Equalize often. The more often you do it, the easier it will be. Is recommended to equalize every meter but basically: equalize as soon as you feel a little bit of pressure
- Always equalize gentle. Forcing the process will only damage your ears.
- You should never feel pain. If you feel pain or if your ears are not “popping”, immediately stop your descend and signal to your buddy and/or to your guide. Then you should ascend a couple of meters and try again. Take your time.
- Plan ahead. If you know that your ears usually dont behave, let your buddy and guide know. If you are in a group of divers, maybe you and your buddy can jump in first to have plenty of time for equalizing. Use a line if that helps. Dont be ashamed of asking for help or speaking up to your guide. The more information he/she has, the easier you will make their job.
- If you are in a diving group, follow tip number 6 and allow yourself approximately 5 minutes to equalize. If you can not get down by this time, you may consider cancelling your dive as the rest of the group will be waiting for you. Also, is not a good idea to force your ears for too much time. Make sure you tell the guide you are cancelling and going up, do NOT go without informing the guide otherwise they may assume you got lost and start a emergency search for you.
- If you usually have ear problems and you want to dive without the stress of the rest of the group wating for you, consider hiring a private guide and take the stress away.
- Be careful with your ears and always ask a professional in case of doubt. Ear problems can be easy to sort out but we should always ask to a doctor if we are not sure.
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Article written by: Laura Quijano