The ear is an incredibly important organ responsible for our hearing as well as our balance. Scuba divers do have to be careful to take good care of their ears as injuries are very common. As this is such an important matter, the Girls that Scuba have discussed different areas concerning the ear and shared many tips on how to avoid issues. These include equalization, ear infections and ear injuries, and you will find a collection of the best tips and more information about the ear in this post. Let's start with some basics about our ear. We all learned about it during our scuba courses, but it is so easy to forget how it all works, as well as where and why issues can arise.

The ear can be divided into the outer ear, the middle ear and the inner ear. The outer ear includes the ear canal where the earwax is produced by glands. The eardrum separates the external ear from the middle ear. 

The middle ear is connected to the throat via the Eustachian tube. The middle ear is filled with dead air and this is the space we have to equalize when we are scuba diving. This is achieved by moving air in or out through the Eustachian tubes.  The pressure in the middle ear has to match the pressure in the outer and inner ear. The Eustachian tubes are normally closed and are only opened under normal circumstances on land when we swallow or when we equalize.

Located between the middle ear and the inner ear are two openings covered by thin membranes – the round and oval windows. These are important to transmit sounds into the inner ear and with it allow hearing. The inner ear is located in a complex cavity called the bony labyrinth. The inner ear is not only important for hearing, but also for balance while moving or stationary.

We won't go into more detail here, as these are the most important parts of the ear to know for scuba divers. If you would like to learn more, check out the page about the ear and ear injuries on the Divers Alert Network (DAN).

Many different techniques can be used to equalize the airspace in the middle ear, or in other words to open the Eustachian tubes. The “pop” or “click” sound we hear when doing so is the air that flows in from the throat to the middle ears.

The most important rule with equalizing is to stop and go up a meter in case you experience any problems or even pain. Never force anything.

The easiest equalizing technique  to learn and teach, and therefore the most commonly used  is the so called Valsalva Maneuver. This is the one where you exhale against a pinched nose and closed lips. 

There is one problem with this method, however, it does not activate the muscles, but only presses air up the Eustachian tube. This might work as long as the tubes are kept open. If you do not equalize early enough the pressure differential might force the tissue together and hence result in closing the tube. At this point, no more equalization is possible. If you then keep descending and forcing harder to equalize this might cause one of the injuries mentioned above.

Of most importance with any technique used that involves blowing against closed nostrils, is to blow very, very, gently and slowly. It should be a gentle constant blow. There are several other techniques scuba divers can use to equalize, like the following:

• pinch the nose and swallow
• pinch the nose, blow and swallow
• tense your throat and push your jaw forward
• close off the vocal cord, pinch your nose and make the sound of the letter “K”

The Girls that Scuba also use many additional tricks together with any of these techniques, listed below.

• tilt your head side to side
• look up
• wiggle your jaw
• massage the tubes
• blow out of each nostril independently
• take off your mask, empty the nose, equalize, put the mask back on and clear it

From all the posts by the Girls that Scuba it becomes clear that it is quite normal to struggle with equalization in the beginning. Even experienced divers might have occasional troubles.  

Equalising becomes second nature once you have been diving long enough. It is also important to find the equalising method that suits you the best. Everyone is different and so what works for one diver might not for  another. 

It is best to try some different methods  until you find the one which is perfect for you. Or you might even change your technique when you get to dive more often.

Most probably the moment when it does get much easier to equalize is when you stop stressing about it. The more stressed you get, the tenser  you become,  and the harder it gets to equalize. So try to relax and stop worrying about people waiting for you, or if you would have to end a dive because of your ears. This is completely fine and it is the same for everyone. Better to take it slowly or end a dive than to hurt yourself.

Equalize early and often

Equalize the first time while  you're still on land, then on the surface  you might want to clear  your nose as well before putting on the mask.  While descending, use a little of every exhale on the way down to keep clearing your ears. Also just equalize randomly sometimes during the dive even if you don't feel the need to. Make it a motor motion that your brain initiates automatically. 

Go slow and feet first

Don't stress  if it takes you longer to get down. This is fine and every dive guide should respect that. When you know that it will take you a bit longer, let your guide or instructor know beforehand. Also the group or your buddy should stay level with you while you slowly descend. Remember to stop immediately and even go up a little bit if you experience any trouble equalizing or your ears start to feel uncomfortable.

Keep practicing

The more dives you do, the easier it will be. And you can also do a dry practice performing any equalization technique on land or in a swimming pool. The more you use the muscles, the better conditioned they are for diving.

Listen to your body

When you don't feel right, don't go diving. If your head feels foggy and full, or your health is not on top, stay out of the water for a day and you can enjoy your dives even more the next day and potentially  avoid damaging your ears. If you are already in the water and it seems like you won't be able to equalize, let your buddy and dive guide know that you want to end the dive and ascend slowly.

Get warm 

Drink tea before diving, during the briefing for example, this helps open up the tubes. It might also help to keep your neck and head warm, avoid air-con as well as breezes and wind in your ears.

Chew before diving

Chewing gum before diving might free the tubes up.

Use rubbing alcohol/vinegar ear drops

A common mix is 50/50 rubbing alcohol and vinegar – the alcohol works against bacteria and dries the ear, while the vinegar makes sure the ear does not dry out too much by the alcohol. 

Wear a hood

it can even be a thin bandana, just to avoid water flow around the ears.

Use oil

Many girls recommend  using a few drops of oil in the ear before the dive which might prevent bacteria to enter or stay in the ear. Recommended oils are baby oil, olive oil, tea tree oil (diluted) and almond oil.

Use a mask that covers  your ears

There are special masks that include parts that cover the ears. For example, one called Pro-ear. For girls with long hair, a little bit of water might still come into the ear area, however, that can be cleared out by blowing out through the nose, like when water is removed from the mask. For divers who often have problems with their ears, this might be the perfect solution.

Or use vented ear plugs

Vented ear plugs are specifically made for scuba diving and keep water out of the ear while allowing to equalize. Never use normal ear plugs, these can cause damage to the ear when air gets stuck underneath and these don't allow to equalize properly.

Keep the ears warm

Stay out of air-con rooms before and after the dives and cover up your ears to avoid wind/breeze to blow in your ears. 

Additionally, you can try wrapping a hot water bottle in a towel and lean the blocked ear onto it and lie there for a while.

Remove wax

Put mineral oil, hydrogen peroxide or specific ear drops from the pharmacy to loosen the wax. You should never do this when you do experience any pain, itchy sensation or any other indication that there might be an infection.

Saline wash

For some, the use of a saline wash (Neti Pot) might help, however, don't do it regularly as it can be too harsh and strip out the natural mucus. Do not snort sea water! It is full of bacteria and can cause infections.