Ear Equalization and Ear Barotrauma

Why your ears hurt

Your middle ear is a small air space behind the eardrum. It connects to the back of your throat through a narrow passage called the Eustachian tube. As you descend, water pressure pushes on the outside of the eardrum while the air inside is squeezed, as Boyle's law describes. Unless you add air through the Eustachian tube, the eardrum bulges inward. This causes pressure, then pain.

The effect is strongest close to the surface, because the pressure doubles in just the first 10 m (33 ft), as explained in water pressure at depth. Many ear problems start in the first 2 to 3 metres of a descent.

Barotrauma

Barotrauma means injury caused by pressure. If you keep descending without equalizing, the pressure difference can bruise the middle ear, fill it with fluid or blood, or tear the eardrum. Middle ear barotrauma is the most common diving injury. Signs include pain, a feeling of fullness, muffled hearing, ringing and, if the eardrum tears, sudden dizziness when cold water enters.

Less common but more serious is inner ear barotrauma, which can cause lasting hearing loss or balance problems. It is linked to forceful equalizing. Hearing loss, ringing or vertigo after a dive should be checked by a doctor promptly.

How to equalize

• Valsalva: pinch your nose and gently blow against it, as if blowing your nose. It's the method most divers learn first. Keep it gentle and never force it.
• Toynbee: pinch your nose and swallow. Swallowing opens the Eustachian tubes.
• Frenzel: pinch your nose, close the back of your throat and push the back of your tongue upward like a piston. Freedivers use it widely because it needs little effort.
• Hands-free: some divers can open their tubes by yawning or moving their jaw, without pinching their nose.

Good habits

1. Equalize gently at the surface just before you descend.
2. Descend feet first, which makes equalizing easier than going head first.
3. Equalize every metre or so for the first several metres, before you feel discomfort, and then regularly as you go deeper.
4. If an ear won't clear, stop, ascend a little until the pressure eases, and try again. Never push through pain.
5. Use a line or the reef slope to control your descent rate.
6. If it still won't clear, end the dive.

Other squeezes

Your sinuses equalize on their own through small openings, but congestion can block them and cause sinus squeeze. Your mask also needs equalizing: breathe a little air out through your nose into it on descent to prevent mask squeeze. Never dive with a cold or blocked nose. Decongestants can wear off during a dive, causing a reverse block, where the air in the ear can't escape on the way up.

Reverse block

A reverse block is the opposite problem: the air in the middle ear can't get out as you ascend. If you feel pressure on the way up, stop, descend slightly, and try swallowing or wiggling your jaw before rising again slowly. Don't use Valsalva for a reverse block.

Frequently asked questions