Ears & Diving

Approximately 40 percent of all calls and emails received by DAN, annually, involve ear and sinus issues. The most common diving injury is middle ear barotrauma. Equalization is a skill that divers must master for safe and effective diving. It can take some time to refine this skill, and congestion can further complicate the matter.

Understanding Equalization
The middle ear is an air-containing cavity. In order to function properly it is necessary to maintain equal pressure between the outer ear and the middle ear. As a diver descends, increasing water pressure causes the ear drums to bow inward, creating negative pressure in the middle ear. The equalization process utilizes the Eustachian tubes, which connect the middle ear to the back of the throat to vent air into the middle ear. Divers must equalize to enable the higher-pressure air from the throat to enter the middle ear to equalize it. Congestion or poorly executed equalization maneuvers can inhibit the process and may lead to injury.

Prevent Injuries
During descent, equalize about every two feet. It is easier to equalize if you descend vertically, feet first, because mucus in the Eustachian tubes tends to drain downward. You can also look up as you try to equalize; this can help open your Eustachian tubes and ease equalization. If you are having trouble equalizing one ear, try tilting it toward the surface as you perform an equalization maneuver. Not everyone equalizes at the same rate. Take your time and never force it. If you are unable to equalize during descent, try ascending a few feet before attempting it again. If this does not resolve the issue, discontinue the descent and end the dive to avoid potential injury.

Learn more than one equalization technique. In addition to the Valsalva maneuver (pinch the nostrils and gently blow through the nose), which your probably learned in your entry level course, try additional techniques that may help you equalize, such as the Toynbee maneuver (pinch the nostrils and swallow) or the Lowry technique (pinch the nostrils, while gently blowing through the nose and swallowing simultaneously). Practice often in a pool, on an airplane during descent or on land prior to diving. When you reach your maximum depth in the water, remember to equalize again. While the pressure changes may feel minimal at depth, it can still slowly cause barotrauma if air spaces aren’t equalized.
If a reverse block occurs on ascent, descend a few feet and repeatedly swallow or try an equalization maneuver; do not force equalization. Then, ascend as slowly as possible.

Keep ears clear of ear wax, ear plugs or tight hoods.

Do not treat ear injuries with ears drops, which are designed to prevent an infection known as otitis externa, also referred to as swimmer’s ear. They will not help when an injury has occurred and may actually cause the injured diver additional discomfort.

Inability to equalize properly can result in ear injury. If you are unable to equalize, discontinue the dive. If you surface with a feeling of fullness in your ears or hearing crackling sounds, experience pain or tinnitus, discontinue diving and seek a medical evaluation. If you experience an injury, do not continue to try to equalize as this may exacerbate the injury.

Learn More
For more information about ears and ear injuries, read the DAN Diving Medicine FAQs on ear equalizing and Stop the Drops! Ear Pain Management. You can also download the “Divers Guide to Ears” and take DAN’s online seminar “Ears and Diving.” If you have any questions, contact the DAN Medical Information Line at +1-919-684-2948 or via email at This email address is being protected from spambots. You need JavaScript enabled to view it. .

Divers Alert Network (DAN) is a nonprofit organization dedicated to the safety and health of scuba divers. DAN operates a 24-hour emergency hotline (+1-919-684-9111) to help divers in need of medical emergency assistance for diving or non-diving incidents.

Approximately 40 percent of all calls and emails received by DAN, annually, involve ear and sinus issues. The most common diving injury is middle ear barotrauma. Equalization is a skill that divers must master for safe and effective diving. It can take some time to refine this skill, and congestion can further complicate the matter.

Understanding Equalization
The middle ear is an air-containing cavity. In order to function properly it is necessary to maintain equal pressure between the outer ear and the middle ear. As a diver descends, increasing water pressure causes the ear drums to bow inward, creating negative pressure in the middle ear. The equalization process utilizes the Eustachian tubes, which connect the middle ear to the back of the throat to vent air into the middle ear. Divers must equalize to enable the higher-pressure air from the throat to enter the middle ear to equalize it. Congestion or poorly executed equalization maneuvers can inhibit the process and may lead to injury.

Prevent Injuries
During descent, equalize about every two feet.
It is easier to equalize if you descend vertically, feet first, because mucus in the Eustachian tubes tends to drain downward. You can also look up as you try to equalize; this can help open your Eustachian tubes and ease equalization. If you are having trouble equalizing one ear, try tilting it toward the surface as you perform an equalization maneuver.
Not everyone equalizes at the same rate. Take your time and never force it. If you are unable to equalize during descent, try ascending a few feet before attempting it again. If this does not resolve the issue, discontinue the descent and end the dive to avoid potential injury.

Learn more than one equalization technique. In addition to the Valsalva maneuver (pinch the nostrils and gently blow through the nose), which your probably learned in your entry level course, try additional techniques that may help you equalize, such as the Toynbee maneuver (pinch the nostrils and swallow) or the Lowry technique (pinch the nostrils, while gently blowing through the nose and swallowing simultaneously).
Practice often in a pool, on an airplane during descent or on land prior to diving.
When you reach your maximum depth in the water, remember to equalize again. While the pressure changes may feel minimal at depth, it can still slowly cause barotrauma if air spaces aren’t equalized.
If a reverse block occurs on ascent, descend a few feet and repeatedly swallow or try an equalization maneuver; do not force equalization. Then, ascend as slowly as possible.

Keep ears clear of ear wax, ear plugs or tight hoods.

Do not treat ear injuries with ears drops, which are designed to prevent an infection known as otitis externa, also referred to as swimmer’s ear. They will not help when an injury has occurred and may actually cause the injured diver additional discomfort.

Inability to equalize properly can result in ear injury. If you are unable to equalize, discontinue the dive. If you surface with a feeling of fullness in your ears or hearing crackling sounds, experience pain or tinnitus, discontinue diving and seek a medical evaluation. If you experience an injury, do not continue to try to equalize as this may exacerbate the injury.

Learn More
For more information about ears and ear injuries, read the DAN Diving Medicine FAQs on ear equalizing and Stop the Drops! Ear Pain Management. You can also download the “Divers Guide to Ears” and take DAN’s online seminar “Ears and Diving.” If you have any questions, contact the DAN Medical Information Line at +1-919-684-2948 or via email at
This email address is being protected from spambots. You need JavaScript enabled to view it. .

Divers Alert Network (DAN) is a nonprofit organization dedicated to the safety and health of scuba divers. DAN operates a 24-hour emergency hotline
(+1-919-684-9111) to help divers in need of medical emergency assistance for diving or non-diving incidents. ■