Ear squeeze is the most common diving related illness. All divers eventually have some ear problem. External infections, sometimes called swimmer’s ear, are not owing to diving itself, but occur when water gets into the ear canal and remains long enough to allow bacteria and fungi to grow. This is best prevented by making an effort to get the water out of your ear canal. Tilt your head sideways and pull on your ear lobe or shake your head. Prevention of external infections is best done by using Otic Domeboro solution  – a few drops in each ear before and after water exposure are adequate.

Clearing your ears requires another consideration. The problem here is that you cannot get the eustachian tubes open to allow air to enter the middle ear and equalize the pressure across the eardrum. Be sure there is no congestion in your nose or throat when you dive, then begin clearing your ears before you descend and continue to clear every foot or two as you go down. Waiting for an ear to hurt before you try to clear is a bad habit and usually results in you being unable to clear. You are obliged to ascend, clear again then try another descent.

Consequences Of Squeeze

Middle ear squeeze produces swelling of the lining of the middle ear and eustachian tube plus fluid accumulation in the middle ear. Often the fluid will not clear until the swelling has subsided and normal eustachian tube function returns. This frequently requires five or six days and occasionally one or two weeks. The presence of other factors such as nasal allergy or irritation from smoking can prolong the recovery period. With middle ear fluid accumulation, sound is not transmitted property to the inner ear, but it still responds to noises which are present in the head and are usually masked by outside sounds. Thus, an occasional hiss or buzzing noise can be heard. Hissing or buzzing sounds following an ear squeeze can represent middle ear or inner ear injury. If these sound are not accompanied by other ear symptoms suggesting inner ear injury – such as vertigo or hearing loss – are not loud or are intermittent, these symptoms are probably related to middle ear squeeze.

As mentioned above, ear squeeze should be avoided by adequately clearing the ears very foot or two during descent. Once a squeeze is present, medical attention should be sought. Most middle ear squeeze can be successfully treated with medication, but you should not return to diving until the ear is completely clear. If you have frequent problems with ear clearing during diving or if the squeeze does not clear within ten days, you should consult an ENT physician. If hearing loss, vertigo, dizziness or loud roaring or ringing noises are present, you should seek prompt treatment with a physician specializing in ENT (Ear, Nose and Throat).

Ear squeeze and scuba diving

Perforated Eardrums

You should not dive with a perforated eardrum. Sometimes cold water entering the middle ear through one will upset your balance mechanism located next to the middle ear and cause sudden vertigo, dizziness or even vomiting. None of these things are conducive to safe diving. Also, when there is a hole in your eardrum, water will enter the middle ear, cause an infection and eventually, with repeated damage, result in hearing problems. However, most eardrum perforations caused by diving are not permanent. First you must let the perforation close and heal before resuming diving. If you rupture an eardrum while diving, you should see a physician, get treatment to prevent ear infection and wait for healing to occur. You may be unable to dive for three to four weeks, but with proper care, the drum will heal. After an examination by your doctor, you should be able to dive again.

Chronic eardrum perforations usually occur when there is poor eustachian tube function. Unless the tube functions adequately, the eardrum perforation will not heal. Frequently, poor eustanchian tube function is related to chronic nasal or sinus disease. Individuals who have a permanent eardrum perforation should consult an ENT specialist. They should not dive until any identifiable causes of poor eustachian tube function have been adequately treated and the eardrum perforation has been repaired. All divers need to be aware the nondiving related chronic middle ear disease indicates the presence of poor eustachian tube function, if this occurs in the absence of significant atmospheric pressure changes. Such individuals are definitely more likely to exhibit inadequate eustachian tube function and middle or possible inner ear barotrauma when exposed to the atmospheric changes encountered in diving.

If you have perforated an eardrum while diving, you should promptly seek medical help to be sure it heals properly. If the drum does not heal, you should see an ENT specialist. All divers should take care to properly clear their ears during descent. Eardrum perforations while diving, owing to inadequate middle ear pressure equilibration during descent, are preventable. Such occurrences indicate an unsafe diving technique, specifically, a descent rate that is too fast with inadequate attention to middle ear clearing.

Round Window Rupture

This is an infrequent problem but one that does occur and is more difficult to deal with than a simple middle ear squeeze. Inner ear barotrauma during sport diving has been related to inadequate middle ear clearing with the development of a negative middle ear pressure during descent. This can lead to rupture of membranes within the inner ear or of the round or oval windows, membranes which normally seal the inner ear fluid from the middle ear. With such rupture, fluid leaks from the inner ear into the middle ear. Round window rupture is more likely to occur if the diver strains or tries to do a forceful valsalva maneuver to clear the ears while at depth. Round or oval window rupture is accompanied by nausea, vomiting, vertigo, hearing loss and noise in the ear. One or all of these symptoms may be present and are frequently noted during ascent or immediately after surfacing from relatively shallow dives not involving staged decompression. Vertigo with possible nausea and vomiting can be life-threatening while at depth. Occasionally, the diver may not notice ear squeeze during the dive. If an ear examination is delayed for five to seven days, signs of middle ear barotrauma may have subsided with the window rupture persisting. If a window rupture is suspected, removal of the diver from the water, bed rest with head elevation, and prompt ENT consultation should be sought. Surgery may be needed to repair the damage.

Another type of diving inner ear injury is inner ear decompression sickness. This is more commonly seen during deep, mixed gas diving, but can be noted during sport diving. Symptoms similar to those described above for inner ear barotrauma or round window rupture are noted. Any diver who notes the onset of such symptoms during or after decompression from dives requiring staged decompression or from dives close to or beyond the no decompression limits should be considered as having possible inner ear decompression sickness. A diving physician should be consulted if this occurs since prompt recompression chamber treatment often results in a return of inner ear function to normal.

Any diver who suffers inner ear injury while diving should have a complete ENT evaluation before returning to diving. The disappearance of vertigo may not indicate that the balance organ in the inner ear has returned to normal function. If such an evaluation reveals significant deafness or inner ear balance organ dysfunction, the diver should not return to diving: Such injuries increase the likelihood of future injuries. Damage to the opposite ear can cause total deafness.

Prevention Of Ear Squeeze

There have been some devices designed for people with perforated ear drums who cannot get their ears wet when diving. I can recall diving with a friend who used them and always complained how difficult they were to use. These earmuff type devices were not intended to help equalize ear pressures and prevent ear squeeze. Rather, they are supposed to keep water out of the ears. To accomplish that it is necessary to maintain the pressure on the ear at ambient pressure. Hence, connection of the earmuffs to the second stage of the regulator or to a facemask is necessary. Although such devices work, the difficulty in using them and the risk of getting a severe ear infection if they leak, has limited their popularity.

No matter what you do to the outside of the ears, the problem with equalizing is from the inside of the ears and throat and there are no artificial tubes which can connect the mask or regulator with the middle ears where the equalization problem occurs. You should learns the various ways to clear you ears. If you still have trouble after using the correct method of clearing, have an ear, nose and throat exam by a doctor who knows something about diving medicine. Before seeking more medical advice, try the following: descend in the water head up (that is go down feet first), begin to clear your ears on the surface, before you begin your descent and clear continuously as you descend. Be careful not to bear down too hard or you will risk a round window rupture and more ear trouble.

Dizziness on ascent may result from alternobaric vertigo and comes from the ears not equalizing at the same time during ascent. The only way to keep the pressure off the ears when diving is to use the complicated one atmosphere diving suit. These are large and very expensive. Made of metal, they maintain a one atmosphere pressure within. They are only used by commercial companies and would not be suitable for sport diving. Riding in a submarine or diving bell would also work.

When diving, all the tissues of the body are subject to the increased pressure and if just the ears are excluded from the ambient pressure, there would be an even greater likelihood of a squeeze.

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