Ready to dive in? Ear check for scuba diving

Diving into the underwater world is an exhilarating adventure that offers a unique blend of freedom and exploration. However, scuba diving is not without its challenges. One of the most significant hurdles divers encounter is equalising ear pressure. Mastering this essential technique can mean the difference between a pleasurable dive and an uncomfortable experience. Every month, I receive a few patients in my clinic for a pre-scuba diving ear check, so in this article, I will examine ear checks for scuba diving, and effective strategies to equalise ear pressure and help you enjoy every moment of your diving journey.

Ear check before scuba diving

When you dive underwater, the pressure surrounding you increases rapidly. For every 10 meters (about 33 feet) you descend, the water pressure increases by approximately one atmosphere (1 ATA).

Let's take a look at the anatomy of the ear below and see what happens when you descend into the water:

• Outer ear - As the water pressure increases, the water movement in the outer ear may move the earwax in the ear canal deep and stick it to your eardrum. So it makes sense to make sure that your ear canal is clean from any blockage of earwax. In a worst-case scenario, the earwax may expand due to exposure to seawater and act as a piston in the ear canal, passing on the increase of pressure to the eardrum. So you can imagine that the first step in preparing your ears for scuba diving is to ensure they are clean.

• Middle Ear - Your middle ear is connected to the top of your throat through a small tube called the Eustachian tube. The Eustachian tube has two roles: a. to equalise the pressure in your middle ear, and b. to drain the fluid or infection material that may have built up in the middle ear. If you have had a cold, sore throat, sinus infection, cough or any inflammation in your neck and up, you may have experienced a runny nose followed by feeling mucus flowing at the back of your throat that you don't have much control over. This mucus could block your Eustachian tube on one or both sides. The symptoms include a feeling that your ear is blocked, or when you swallow your saliva, you hear popping or crackling in your ear. A clean and open Eustachian tube is vital in equalising the pressure in the middle ear while scuba diving. Please see this article on how you can clean and manage the blockage of your Eustachian tubes.

• Inner ear—The inner ear is not mechanically or hydraulically connected to its surroundings, so there is nothing to clean or check in it.

  
  

How to protect your ear canal from a fungal infection before scuba diving

If you head on to a vacation in warm places or plan a scuba diving trip, you may want to consider a few simple steps to protect your ears from picking up a fungal infection.

1. Ear wax removal - Ensure that there is no earwax buildup before you begin your vacation. Even a 50% earwax buildup can trap water in your ear. A warm and dark environment in your ear canal is a perfect environment for a fungal infection to form and grow.

2. Swimmer's ear spray - A thin layer of earwax in your ear canal is the best natural protection for your ear canal. However, the ear canals of some people do not create much earwax. Or, if you wish to double down on ear protection before scuba diving then you can try protection sprays. There are ear swimmer sprays that are thicker than olive oil, so when sprayed, they create a sealed protection in the ear canal that stays for a few hours. Here is one by Earol.

   
   

How to clean your ears after scuba diving

It is a good habit to wash your ears after each dive. Gently rinsing the ears with fresh water after each dive may help. A more strict approach to cleaning your ear after scuba diving is to gently rinse with warm water, dry thoroughly, and consider using a solution of equal parts white vinegar and rubbing alcohol to help prevent a swimmer's ear or fungal infection.

The importance of equalising while scuba diving

Equalising ear pressure is crucial for several reasons:

1. It allows for a more comfortable descent and ascent. When equalisation is done correctly, you can focus on enjoying the amazing marine life around you rather than worrying about ear pain.

2. It prevents possible injuries, such as ruptured eardrums or inner ear complications. According to a study, roughly 10% of divers report issues related to pressure equalisation.

   
   

To maximise comfort during your dives, it's essential to equalise every few feet as you descend. Staying attuned to your body's signals will enhance your diving experience.

How to equalise ear pressure while scuba diving

1. Valsalva Manoeuvre

The Valsalva manoeuvre is among the most widely used methods by divers to equalise ear pressure. Here’s how to perform it effectively:

1. Pinch your nose closed

2. Close your mouth

3. Gently blow against your closed nostrils while keeping your mouth shut

   
   

This method pushes air into the Eustachian tubes, helping to equalise the pressure in your ears.

2. Toynbee Manoeuvre

The Toynbee manoeuvre offers a gentle alternative. Follow these steps:

1. Pinch your nose closed

2. Swallow while keeping your nose pinched

   
   

This action helps open the Eustachian tubes, allowing for a more gradual equalisation than the Valsalva manoeuvre.

3. Frenzel Manoeuvre

For advanced divers, the Frenzel manoeuvre may be beneficial:

1. Pinch your nose

2. Close your throat as if getting ready to swallow

3. Use your tongue to push air into your nasal passage

   
   

This technique is particularly useful if standard methods are ineffective.

4. Using Jaw Movements

Sometimes, simple actions with your jaw can assist with equalisation. While descending, try to:

1. Yawn widely

2. Chew gum or suck on hard candies

   
   

These movements can help naturally open your Eustachian tubes, making the process easier.

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When to equalise while scuba diving

Knowing when to equalise is just as important as knowing how. Divers should begin equalising before they feel any discomfort in their ears. It is advisable to equalise every few feet during descent, stop to assess your comfort level if you feel any pain, and never rush through the process.

On ascent, equalising is typically unnecessary since pressure decreases. However, if you start feeling discomfort, repeat your chosen equalisation technique.

Common mistakes to avoid in equalising pressure while scuba diving

To maximise safety and comfort, be aware of common pitfalls:

• Forcing equalisation: Do not attempt to force the process. If it does not work immediately, wait a moment and try again gently

• Ignoring discomfort: If you experience pain, stop your descent and relax. If needed, ascend slightly before trying to equalise again

• Descending too quickly: A controlled descent allows time for natural equalisation, reducing the risk of injury

  
  

Practising and being aware of these mistakes can lead to a much safer diving experience.

To make equalising ear pressure as stress-free as possible, consider the following recommendations:

• Stay relaxed: Tension can hinder your ability to equalise effectively. Remaining calm allows you to better focus on the techniques.

• Use a dive buddy: For beginners, diving alongside an experienced partner can provide guidance and support

• Practice on dry land: Familiarising yourself with equalisation techniques on land can help make them easier when you are underwater

  
  

HearingNow started offering Phonak hearing protection products, including Phonak sleeping earplugs, music earplugs, work and shooting earplugs. The range of Phonak Serenity Choice earplugs comes in custom-made as well, which requires a visit to our clinic for impression taking from your ears.

Happy diving!

Disclaimer: The information provided in this article is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment. Reliance on the information provided on this blog is solely at your own risk.

References and additional readings

• Eustachian tube dysfunction and how to manage it

• PADI website

• Ear equalization while diving