Ear Barotrauma – The Most Common Scuba Diving Injury

Written by Tegan

Have you ever felt like you had water stuck in your ears or had muffled hearing after a dive? If so, you may have already experienced a mild ear barotrauma without realizing it. Ear barotraumas are the most common injury in recreational diving, yet with proper equalization techniques they are completely avoidable.

What Is Barotrauma?

A barotrauma is a pressure related injury (baro refers to pressure and trauma refers to an injury). There can be many kinds of barotraumas in diving, such as lung, sinus, and ear barotraumas.

What Causes Ear Barotrauma?

An ear barotrauma occurs when a diver cannot properly equalize the pressure in his ears with the surrounding water pressure. Common causes of an ear barotrauma are ineffective equalization techniques, congestion, exceedingly forceful equalizations, or skipped equalizations.

Ear barotrauma can occur at any depth, but is most common at shallow depths where the pressure change per a foot is the greatest.

If the pressure difference between the middle and outer ear is greater than about 2 psi (pounds per a square inch) a diver’s ear drum will be distorted to the point that he is likely to feel pain and discomfort. This pressure difference can occur by descending as little as 4-5 feet without equalizing. If the pressure difference between the outer and middle ear is 5 psi or greater, an eardrum rupture is likely.

Types of Ear Barotraumas

• Outer Ear Barotrauma
Middle Ear Barotrauma
Inner Ear Barotrauma

Symptoms of Outer Ear Barotrauma

During an outer ear barotrauma, a vacuum of pressure is created in the outer ear as a diver descends. This vacuum sucks the eardrum outwards and distends blood vessels and skin of the outer ear. Divers experiencing an outer ear barotrauma have reported pain and difficulty equalizing during descent. Signs may include small amounts of blood trickling from the ear canal after the dive.

Treatment and Prevention of Outer Ear Barotrauma

The burst blood vessels or damaged skin will generally heal themselves. To prevent future outer ear barotraumas, you should avoid using tight fitting hoods and ear plugs. Also, ensure that your outer ears are free of wax and other blockages.

Symptoms of Middle Ear Barotrauma

On Descent:

Divers report a build up of pressure and eventually pain, accompanied by an inability to equalize. There can be soreness and pressure on the eustachian tubes too as they begin to collapse from the negative pressure.

If a diver keeps descending without equalizing, the vacuum in his middle ear cavity may eventually pull on his eardrum, and it can eventually burst. Divers who have thus perforated an eardrum report a build-up of pain and pressure and then a feeling of relief as the ear drum bursts. This sensation is usually followed by a rush of coolness as water flows into the middle ear.

On Ascent:

On ascent, it feels similar to a middle ear barotrauma on descent. But the process is reversed. This is called a reverse block. Expansion of air in the middle ear on ascent causes over-pressurization of the middle ear, pushing out on the tissues and membranes. The consequences are much the same.

After the Dive:

Mild middle ear barotraumas may be recognized after a dive by the feeling of “fullness” or “water in the ears” that cannot be relived. This is caused by the accumulation of blood and body fluids in the eardrum and middle ear, not by water in the outer ear. Divers experiencing a persistent feeling of water in their ears after a dive should get checked by a doctor. You shouldn’t dive till the sensation subsides.

Muffled hearing, dizziness, popping or crackling sounds while moving the jaw, soreness of the eustachian tubes and ears, squeaking noises during equalization on subsequent dives, and fluid leaking into the throat from the eustachian tubes are all signs of middle ear barotrauma.

Treatment of Middle Ear Barotrauma

You should meet a doctor or ENT specialist immediately for a diagnosis if you experience the symptoms of a middle ear barotrauma. The severity and treatment of a middle ear barotrauma can vary.

In mild cases, many doctors will prescribe a simple decongestant to clear the eustachian tubes and fluids from the middle ear. Antibiotics may be prescribed if an infection is suspected. Topical drops usually don’t work.

Symptoms of Inner Ear Barotrauma

Divers with inner ear barotrauma have a tearing. Most divers report an immediate feeling of vertigo, possibly accompanied by nausea or vomiting. Vertigo and vomiting can be disorienting, even life-threatening, underwater. Hearing loss and tinnitus are also common signs of inner ear barotrauma.

Treatment of Inner Ear Barotrauma

Inner ear barotraumas are among the most serious ear injuries for a diver. They require immediate medical attention both for treatment and diagnosis. Inner ear barotraumas sometimes heal themselves with bed rest, but they frequently require surgery and may be a contraindication for diving in the future.

How Can You Avoid An Ear Barotrauma?

– Don’t dive if you are sick or congested. The eustachian tubes may be congested or swollen and will not allow for efficient equalization.
– Learn to equalize properly.
– Never equalize forcefully.
– Equalize once on the surface before descending. This provides a cushion of air in the middle ears, pre-opens the eustachian tubes and gives you a margin of error in case you neglect an equalization in the first few feet.
– If you commonly have ear problems, descend feet first and head up.
– If you have equalization problems frequently, some doctors recommend practicing equalization on land daily. With practice, equalization becomes easier as you train your body to equalize properly.
– If you are prone to equalization problems, confirm that you can equalize your ears on land before beginning to dive. If you can’t equalize on land, you will not be able to equalize under water.
– Don’t use ear plugs, tight hoods, or anything that can trap air in the outer ear.
– Don’t dive with even a mild barotrauma. This will only worsen the injury.

An informative video about equalizing

Bottom Line

Ear Barotrauma are a common diving injury which can be avoided through correct equalization. It can occur at any depth but generally occurs in the shallows where the pressure change is greatest per foot.

About the author



Part time mermaid, full time ocean addict, Tegan has been scuba diving and snorkeling for most of her life. She has a wealth of knowledge of the underwater lifestyle and is a key contributor and product tester for all things water related

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