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Ear Pressure Equalization

Submitted by admin on 2011-04-26

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Many people experience severe ear pain, even when diving in a swimming pool, and automatically assume that they will have to deal with the same situation while scuba diving. This can easily be avoided if the techniques of ear pressure equalizing are correctly applied.

As one dives deeper, the water pressure increases and it is therefore extremely important for divers to equalize their ears to prevent serious damage, such as rupturing of the eardrum, while diving.

The ear consists of 4 basic structures. The outer ear, which is open and filled with air, experiences the same pressure as the outside environment. The middle ear is air-tight and air moves in and out through the Eustachian tube. The Eustachian tube links the ears to the nose and throat. If the Eustachian is open, the air flows from the nose and throat into the ears. Usually the air in the middle ear is trapped, as the Eustachian tubes are generally closed. The eardrum divides the outer and middle ear and consists of a thin tissue.

The pressure on the outer ear increases as a diver descends due to the fact that the outer ear is affected by the pressure of the surrounding environment. The pressure in the middle ear stays unchanged and this pressure difference between the outer and middle ear creates pressure on the eardrum. This is commonly referred to as “ear squeeze" and causes the eardrum to bulge away from the higher pressure, leading to the bursting of the eardrum with extreme pain, a ringing sound in the ears and sometimes even blood in the ear canal.

Ear pressure equalization during the descent of a dive is therefore vital and can be achieved by opening the Eustachian tube and allowing the higher pressure from the throat to enter the middle ear. Through this process, the pressure on the eardrum is equalized and leads to a "popping" sound.

There is no definite rule as to how often a diver should perform ear pressure equalization. It is however important, to equalize prior to any pain or discomfort, and it is generally recommended that equalizing should be done continually during the descent.

There are various techniques used for ear pressure equalization during descent. When using the "Valsalva Maneuver", the nostrils are pinched closed and the diver should blow softly through the nose. The "Frenzel Maneuver" is similar to the "Valsalva Maneuver" but one should swallow at the same time.

It is not generally necessary for divers to be concerned with ear pressure equalization when ascending but if the ears are not equalizing automatically the diver may experience discomfort when the eardrum moves outwards. This is known as "reverse block" or "reverse air squeeze" and can be accompanied by dizziness (alternobaric vertigo) which is caused by only one ear equalizing. To solve this problem, try using the "Toynbee Maneuver" which is used for ear pressure equalization on ascent. The diver should pinch the nose closed and swallow, sucking any air pressure out of the middle ear.

Scuba diving is not recommended for anyone suffering from any upper respiratory tract infections or severe nasal allergies, as the Eustachian tubes will become blocked by mucus and could inhibit successful ear pressure equalization. If one is subjected to rapid pressure changes when suffering from a sinus infection, the result is often extremely painful and can extend from the ears to the head and even the eyes, causing splitting headaches and severe ear pain, it can even lead to the ear drum bursting.


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I can testify to the pain experienced when you encounter pressure changes with a sinus infection, I recently made the mistake of travelling by aeroplane with a severe sinus infection which, with all pain aside, resulted in a ruptured ear drum.
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