The most common health complaint from scuba divers is ear pain, often called "ear squeeze," something that will be experienced by most divers at some point. Although the majority of diving-related ear conditions aren't serious, if the right precautions aren't taken, ear pain and discomfort could lead to permanent hearing loss.
Identification
The middle ear is an air-filled space formed by bone and the tympanic membrane, or eardrum, and is connected to your throat by the eustachian tube. When air passes through the eustachian tube, it keeps the pressure in the middle ear equal to that of the outside world. But if the eustachian tube malfunctions and a pressure difference occurs across the eardrum, then barotrauma, or injury from pressure, can lead to ear pain. Every foot you dive below the surface increases the pressure on your ears, which is why you learn techniques to help equalize the pressure as you dive.
Significance
It's often a misconception that decompression sickness, or "the bends," is the most common cause of injuries to divers. In fact, ear injuries are far more common. Because of the rapid relative gas volume change as you descend at the beginning of a dive, the first 14 feet of the descent is where your ears are at most risk of injury. A study published in "Biomedical Research" in 1990 found that divers demonstrated greater hearing loss compared to controls, leading the researchers to conclude that diving over the long term can cause permanent damage to your hearing.
Types
There are different types of diving-related ear pain, such as ear drum pain, or myringitis, caused by hitting the water with the side of your head; outer ear infections, or external otitis, where the ear canal swells and causes pain; middle ear infections, or otitis media, which can happen if you blow your nose too hard while trying to equalize pressure, forcing any bacteria into the ear; blockage on descent, where the air expands in the ear canal and, if not relieved, can rupture your ear drum; and rupture of the round window, or a perilymph fistula, the most serious injury that occurs when you force blocked ears open with too much pressure, providing an opening for inner ear fluid to escape and lead to permanent hearing loss. Also, although not an injury per se, vertigo, or dizziness, can occur when your ears can't equalize the pressure.
Considerations
There are several conditions that may prevent you from diving, such as the inability to equalize air pressure in your ear, even after trying all the various techniques. If this is caused by polyps or nasal septum deviation, then you can have those problems treated and successfully resume diving. If your ear's tympanic membrane has been perforated, you shouldn't dive until it's fully healed. Some doctors also recommend that you not dive at all if you tend to have recurrent ear infections.
Prevention/Solution
You should learn how to properly equalize the pressure in your ears via such techniques as the valsalva's maneuver, where you take a small breath while holding your nose and attempt to force air through your closed nostrils. It also helps to go down on a line feet first, never head down, and equalize your ears every five feet. If you have any congestion prior to diving, you should use nasal irrigation with saline or other nose drops combined with a decongestant. If you sometimes have problems clearing your ears, you can try taking proteolytic enzyme tablets three days before you dive. Ear infections or ruptured ear drums may require a trip to your doctor for prescription antibiotics. The most serious condition, rupture of the round window, may require cortisone or surgery. If you have vertigo, you may need a drug such as Valium.
