Ear Barotrauma

Identifying ear barotrauma early is crucial. Symptoms can range from a feeling of fullness or mild pressure in the ear to sharp pain. Other indicators include muffled hearing, ringing in the ears (tinnitus), or a sensation of fluid in the ear. In more severe cases, you might experience severe pain, vertigo, nausea, or even bleeding from the ear. These symptoms typically manifest during or shortly after a dive.

Barotrauma is often graded by severity. Grade 0 is a feeling of fullness, while Grade I involves redness of the eardrum. Grade II shows mild bleeding in the eardrum, and Grade III includes more significant bleeding and fluid in the middle ear. Grade IV is a complete perforation of the eardrum, and Grade V involves both perforation and bleeding into the middle ear. Understanding these grades helps divers and dive professionals assess the necessary course of action and recovery time.

Prevention is always better than cure, especially with ear barotrauma. The most critical step is to equalise early and often. Start equalising gently on the surface before you even begin your descent, and continue every few feet. Common techniques include the Valsalva manoeuvre (pinching your nose and exhaling gently), the Frenzel manoeuvre (pinching your nose and contracting throat muscles), and jaw wiggles or swallowing. Find the method that works best for you and practise it.

Avoid diving with a cold, allergies, or any upper respiratory infection, as these can block the Eustachian tubes, making equalisation impossible and significantly increasing your risk. If you experience discomfort or pain, ascend a metre or two and try equalising again. Never force equalisation. If you cannot equalise comfortably, it's safer to abort the dive than risk injury. Staying well-hydrated and avoiding alcohol before diving can also help keep your mucous membranes healthy.

Liveaboard diving often involves multiple dives per day for several consecutive days, increasing the cumulative strain on your ears. This heightened exposure means that consistent and gentle equalisation is even more critical. Fatigue from multiple dives can sometimes make divers less diligent, so maintaining awareness of your body and equalisation technique throughout the trip is essential.

On a liveaboard, if you develop ear barotrauma, your diving activities will likely cease for the remainder of the trip to allow for healing and prevent further injury. This can be disappointing, especially when you've travelled far for the experience. Therefore, proactive prevention, including avoiding diving if you feel congested, and seeking advice from the dive professionals on board at the first sign of discomfort, is paramount to ensure a full and enjoyable liveaboard adventure.

Myth: If your ears hurt, just push harder to equalise. Fact: Forcing equalisation when you feel pain can actually worsen barotrauma by increasing the pressure differential or causing tissue damage. If you feel pain, ascend a metre or two, try a different equalisation technique gently, and if unsuccessful, abort the dive.

Myth: Earplugs protect your ears from pressure changes. Fact: Standard earplugs are designed to keep water out, not to equalise pressure. In fact, they create an air pocket that cannot equalise, significantly increasing the risk of external ear barotrauma, which is equally painful and damaging. Special vented earplugs exist, but their effectiveness is debated, and they are generally not recommended for new divers.

Myth: You only need to equalise on descent. Fact: While descent is the primary risk for middle ear squeeze, you also need to equalise on ascent, though it's usually passive. If you have congestion, trapped air can expand and cause 'reverse block', leading to pain and potential damage. Always ascend slowly and listen to your body.