Deep-Six Underwater Systems, Inc.
"Add Depth to Your Life"

Table of Contents

1 Pressure and Gases
2 The Face Mask
3 The Snorkel
4 The Fins
5 Weight Systems
6 The Knife
7 The Wetsuit
8 Pressure and Water
9 The Ear and Pressure
10 The Sinus and Pressure
11 The Stomach/Intestine and Pressure
12 The Lung and Pressure
13 Barotrauma caused by External Air Spaces
14 The Buoyancy Compesation Device (BCD)
15 The Scuba Cylinder
16 The Scuba Cylinder Valve
17 The Regulator
18 Density and the Diver
19 The 4 Gas Laws
20 Hand Signals
21 Carbon Monoxide Poisoning
22 Hyperventilation
23 Nitrogen Narcosis
24 Diver's Flags
25 Sound Underwater
26 Color Underwater
27 Decompression Sickness
28 Breathing Oxygen
29 Deep Diving
30 Thermoclines
31 Thunderstorms
32 Underwater Life
33 Open Water Dives
34 The Final Examination
35 The Environment
36 Advanced Course

9 - The Ear and Pressure

     There are 3 main parts to the human ear. The outer ear is the part you see including the hole that goes into the head to the ear drum (tympanic membrane). The middle ear starts on the other side of the ear drum and is a hollow space that is about 1/2" in diameter. The inner ear consists of fluids and solids. Since the outer ear is open to the water there is little concern for pressure-related injuries in it. There is no gas in the inner ear usually so the same is true for that. The middle ear is a gas space and is subject to compression and expansion in accord with Boyle's law. 

     On one side of the middle ear is the ear drum. It is a flexible membrane. On the other side is a small tube, the eustachian tube, which connects to the throat above where the back of the mouth is. So, there you have it: Go down in the water and the middle ear tries to contract. The ear drum is pushed inward by the high pressure of the water in the outer ear. The discomfort turns to pain as the ear is being damaged.. As the pain increases more damage is done. If the situation does not change the ear drum could rupture allowing cool water to enter the middle ear. That will cool down the inner ear's semicircular canals. They provide you with orientation. The diver gets dizzy and loses the ability to distinguish between going up and down. This is not a pleasant experience underwater!

     It is important to keep the pressure inside the middle ear the same as the ambient water pressure! This will prevent ear barotrauma (baro=pressure-related; trauma= injury). It is also known as, "Middle Ear Squeeze." The eustachian tube is the key. Before the diver descends air should be forced up the eustachian tube to open it up and add pressure to the middle ear. It is best to descend feet first (head up). As the diver descends more air should be forced up the eustachian tube as water pressure is added to the outer ear. This may not always be easy because the eustachian is not totally open in the throat. Air has to be gently forced up the tube. That is best done with a valsalva maneuver: Block the nose, put the tongue against the roof of the mouth, and GENTLY blow into the nose. With a mask the nose may be blocked using both thumbs at the bottom, or, if there is a nose piece, just pinch the nostrils. After the valsalva the ears should feel normal. If they don't "clear" stop descending. Go up a little and try the valsalva again.  Do not descend unless the ears are clear. When you feel pain, damage is being done! If you feel pain you have gone too deep and should ascend immediately.

     The eustachian tube is almost closed where it joins the throat. That is why it is difficult to get air to go into it and then up into the middle ear. If the pressure in the throat gets too great, and the pressure in the middle ear has not been increased the eustachian tube may close completely and not allow any air to enter it. That is why it is important to push air into the middle ear before going down even a few feet. But this has to be gentle. Trying too hard to force air into the middle ear may have the same affect as going too deep before trying to "clear the ears." Some divers are so persistent in trying to force air into the middle ear they actually shut down the entrance of the eustachian tube, just as if they went too deep before trying to clear the ears. The valsalva MUST BE GENTLE! If you hear a crackling sound that indicates the eustachian tube has opened.

     A Case in Point: A diver did a back roll off a boat in the Caribbean. He had too much weight on his belt and no air in his BC. His descent was rapid and he could not clear his ears.  There was a lot of pain in both ears. Finally at about 25 feet he was able to do a forceful valsalva. Either the stirrup bone in the middle ear, or the greater pressure in the inner ear caused the round window to rupture. Inner ear fluid flowed into the middle ear. The diver was dizzy for years and orientation was hampered.

     Many divers resort to decongestants prior to diving to reduce any mucus covering the eustachian tube, and to shrink the membranes around the tube to open it up. It usually works. However, if the decongestant wears off during the dive it is possible for mucus to build up again. This could lead to a reverse block, which is explained below. It is also not wise to use nasal decongestants day after day.

     There are other methods in getting air to go up the eustachian tube. Yawning and swallowing, not so easy to do underwater, and not as successful with most divers as the valsalva is, can stretch the muscles in the throat which will open the end of the eustachian tube allowing high pressure air to enter the middle ear. Chewing gum on an airplane accomplishes the same thing. Holding the nostrils and making the sound of the letter "K" sometimes works.

     Reverse blocks occur when air gets into a space on the descent but cannot get out on the ascent. It can happen in the ear, lung, tooth, sinus, and stomach. In the ear it might happen if mucus is in (or forced into) the middle ear. The air might pass freely by the mucus on the way down , but when the diver ascends the mucus could act as a plug. If the diver continues to ascend the ear drum could rupture outward. In this case, prevention would be to not forcefully do a valsalva that could send mucus up the eustachian tube. Treatment would be to descend if pain is felt on the way up, and then ascend very slowly to allow the air to escape without pain. Some divers have found that if a valsalva is done it sometimes pushes the mucus block aside. All of this is good reason to avoid running low on air in your scuba tank!

     It has been thought an ear plug, similar to those worn by swimmers, could be inserted in the outer ear in order to prevent pressure on the ear drum. This is foolish. As a diver descended with an ear plug it would be forced into the ear by the water pressure. That would be a serious problem! Since the plug would move into the ear the pressure would still increase so the middle ear squeeze would not have been avoided.

     On occasion divers experience a lightheaded, dizzy feeling while ascending. It is caused by the ears not decompressing equally. One ear may clear easily as the diver goes up and the other may be partially blocked. This ascent vertigo usually goes away in less than 1 minute after the diver stops ascending or reaches the surface.

     In the unlikely event the diver has serious barotrauma to one or both ears it is imperative professional medical advice is obtained in order to prevent possible permanent damage resulting in hearing loss!

     Ear infections are one further consideration in diving. For that matter, whenever you get water in your ears there is a chance an infection may occur. The water can be as clean as distilled or from a filthy sewer pipe. It's the water that causes the problem, not the quality of the water.

     Water causes the wax in the outer ear to be removed. The more wax, the more water it will take to remove it. If you keep your ears very clean then it does not take too much water to cause an infection. When the wax is removed the pH of the skin will be changed by water contact and it will support bacteria that are just waiting to make you miserable. If the pH becomes too high (alkaline) bacteria will multiply and create the infection known as "Swimmer's Ear." Once this happens it's time to visit the doctor, go on antibiotics, and stay out of diving for at least 2 weeks!

     Divers and swimmers MUST prevent Swimmer's Ear. Religiously, it is important to keep the bacteria from gaining hold. There are at least 2 methods to do that. After each day of swimming, diving, showering, etc. either alcohol or acid must be put in the outer ear. Rubbing (Isopropyl) alcohol will do 2 things: Dry out the ear and kill bacteria. Boric acid, or dilute acetic acid, will keep the skin acidic and that will prevent the ear from becoming infected. THIS MUST BE DONE AFTER EVERY DAY OF WATER ACTIVITIES! If you do not have either the alcohol or the acetic acid use white wine. It contains both. If an infection begins neither the alcohol or the acids will do anything to stop it unless you follow a regimen that I cannot publish in this on-line book

Copyright Information about this text, DIVING WITH DEEP-SIX is as follows: Copyright 1996 - 2007 by George D. Campbell, III; President. All Rights Reserved. This file may be posted on Electronic Bulletin Boards for download, but may not be modified, printed for distribution, or used for any commercial purpose without the author's written permission. is using this material with the permission of Deep Six. The full version is available at:
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