Since 1997
Dealing with Ear Problems
by DAN Medical Team on March 3rd, 2016

​I have been certified for four years but do little diving since I burst a blood vessel or perforate an eardrum once or twice a year. This always occurs in the same ear. The easiest way for me to equalize is to swallow, but sometimes my mouth is dry. I have to try several times to equalize. Sometimes I have no problems on the first dive, and then on the next dive it seems I will never be able to equalize. I may go days before a problem occurs. I don't know if I am trying too hard, nervous or don't concentrate. I only know that it worries me and takes a lot of joy out of diving for me and my husband. 
​Difficulty equalizing the air spaces of the middle ear and sinuses is the most common problem and injury among recreational divers. If you're experiencing problems with equalizing, the first thing to do is consult with your personal physician or an ear, nose and throat specialist who can evaluate your problem. Believe it or not, it may be something as simple as a chronic inflammation from allergies, to household plants or pets. The irritation and inflammation resulting from an allergy can narrow the air passages and restrict the flow of air in and out of the middle ear.

Your problem may also be from damage to your Eustachian tube from an infection that occurred years ago. There may not be anything your physician can do for such a chronic problem, but decongestant medications may be available that can shrink swollen tissue and allow air to move freely in and out of the middle ear space. Your physician can assist you in finding the best and most effective medication for you; you may have to try several. Some doctors recommend certain nasal sprays that also help shrink chronic swelling in the mucus membranes, but these are short-term solutions that can be used a limited number of times. Additionally, you will need to consider the possibility of side effects any nasal spray or decongestant medication may produce.

Finally, remember to clear before you get into the water. This helps you to make sure you don't have a problem that could be corrected at the surface before you dive, such as taking a drink of water to keep your mouth moist. You may need to simply add something new to your current clearing technique, such as clearing as often as every 1 to 2 feet/0.3 to 0.6 meters in order to prevent further injury. Make sure that when clearing you do it gently and before the problem becomes severe. Waiting too long will cause unnecessary pain, and a forceful clearing attempt by pinching your nose at that time may cause middle ear damage. Several gentle maneuvers and switching back and forth between swallowing and pinching your nose and gently blowing may be the ticket to a trouble-free dive. Above all, if you cannot equalize, abort the dive.


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4 Comments

Natasha Rogers - May 12th, 2016 at 4:24 AM
Thank you for this article it is helpful. I thought I help with additional findings... Where I recently been experiencing ear problems and it was also due to stress whereby their is nerves also effects the ears. The neves come out of all holes found in your first two vertebra C1 and C2 and they get clamped .... Therefore in my case I could not rotate my head as far as the norms and this all also added to the pain and was advised to go to a Kiropractor to release the tention. This all worked very well in my case.
Dr Frans Cronje - May 12th, 2016 at 7:35 PM
Hi Natasha. Thanks for this. You point out very well how integrated ear equalization is: In your case, impingement of spinal nerve roots (C1 & 2) impaired your ability to tilt or rotate your head to effect equalization. As you so rightly say, equalization is not only about the nasopharyx and Eustachian tube function! BTW. You may also find it very important to position your SCUBA tank at the right height in your BC to avoid needing to hyperextend your head and avoid bumping the pillar valve. Thanks for the great comments!
Amanda Ellis - May 12th, 2016 at 9:32 AM
Hi Thanks for the lovely email i have been suffering for 4 years now only from 2m to 5m and today i went to see an ear lady i have tried everything under the sun from otovent to docs proplugs to evey nasal spray and so told to practise every other day to get my ears used to the different pressure groups. But i do recomment the otovent if you can oder one online i does help but need to use it every day. and with the correct technique the doc's proplugs should also work .
Ill let you know how i do after a few practises in land
Dr Frans Cronje - May 12th, 2016 at 7:42 PM
Thanks Amanda. Getting Ears to co-operate during diving can be a challenge! I appreciate your level of commitment towards finding solutions. Usually it is wise to follow a fairly systematic preparation routine so that you can find out what is essential and what is unnecessary: (1) Avoid dairy products or any potentially allergenic food (gluten, etc.) for 48 hours before a diving expedition or trip; (2) Use Nasal or Sinus rinse for 48 hours before diving -- 2 to 3 x per day (depending on the amount of drainage); be very careful not to blow saline into the Eustachian tube; (3) Use Drixine or Iliadin 4 hours before diving, lying flat with the neck slightly hyper-extended. Insert 2 to 3 drops per nostril; turn the head to the right and the left for a minute each; sniff whatever has remained in the nose; and then sit up and blow the nose; (4) Wait about 5 minutes for everything to settle and then use the otovent twice per nostril; (5) by then you should know if you are ready to dive or not. If this regimen proves insufficient, then the role of nasal cortisone spray; non-sedating antihistamines; nasal septum straightening; etc. may need to be considered. Most folks find that this works very well, however. All the best, and let us know how it goes.
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