Divers and Ears: a question of equalizing

Equalizing your ears is one of the first skills that new divers learn and that we practice on every single dive. While building up dives, equalization becomes almost instinctive for many divers. For some divers equalizing remains difficult, frustrating and even painful.

Let’s have a look into the process, the techniques and what can make equalizing problematic.

The anatomy of the human ear

Without going in too many details, the human ear can be segmented in 3 major parts: the outer ear, the middle ear and the inner ear.

The outer ear is at the surface filled with air. When being submerged, our outer ear fills with water and does not cause any issues. The inner ear is filled with body fluids. As a liquid is almost non-compressible, the inner does seldom cause an issue when diving. The middle ear is a dead air space filled with air. When diving the air in the middle ear is getting compressed and puts the ear drum and the inner soft tissues under pressure. It are these pressure changes you experience during scuba diving. As we descend, the surrounding pressure increases, while the pressure in your middle ear remains the same. The imbalance can cause extreme discomfort.

Through equalization we re-balance the pressure in our middle ear by increasing or decreasing the gas pressure in order to match the pressure at depth. We do this though the Eustachian tube which connects the middle ear with our nose.

Inner Ear

The Eustachian tube

The Eustachian tube makes the connection between our middle ear and our nose. As we are breathing gas at depth, our nose contains air at the same pressure as the environment. The Eustachian tube is made of and surrounded by soft tissue. You can look at it as a balloon. When the pressure in the balloon is higher that the surrounding pressure, the excess air will easily come out. This is what typically happens when you are ascending during the dive. When descending, the balloon holds gas at a lower pressure, pushing the sides to each other thus blocking air flowing into it. In order to equalize the pressure, you must force the sites to open up and let air flow into the balloon.

Equalization techniques

The Valsalva Maneuver is the most common method and the one you probably learned during your certification. This involves pinching your nose and blowing gently (like blowing your nose in a handkerchief), thereby forcing air to move along the Eustachian tubes and into your middle ear. The excess pressure from the lower part of the Eustachian tube is forced open and allows air to flow in the middle ear. It is effective as long as you use it in a timely fashion. However, if you wait until discomfort occurs to try equalizing this way, it often doesn’t work. If the outside pressure becomes too great, the Eustachian cushions become “locked” shut – and no amount of air will open them. Instead, if you blow too hard, you risk causing damage to your inner ear tissues.

An alternative is to try pinching your nose and swallowing (a method known as the Toynbee Maneuver), or moving your jaw as if you’re about to yawn. These techniques use the throat muscles rather than air pressure to open the Eustachian cushion and are usually more effective if the valves are already locked shut. Of course, the easiest way to avoid this problem in the first place is to equalize before the pressure becomes too great, i.e. every meter of your descent, or before experiencing discomfort.

Checklist for effective equalization

  • Listen for the “pop”
    Before going for a dive, make sure that when you swallow you hear a “pop” in both ears. This tells you both Eustachian tubes are opening.
  • Take  it slowly
    Never continue to dive if you feel pain in your ears. Take it slow and attempt to equalize. Don’t let your buddy or your dive guide put you under pressure.
  • Start early
    Before the dive, begin gently equalizing your ears every few minutes. Chewing gum seems to help because it makes you swallow often.
  • Equalize at the surface
    Pre-pressurizing at the surface helps most divers get past the critical first few meter of descent. It may also inflate your Eustachian tubes so they are slightly bigger. Although not proven to be the most efficient,  it’s worth trying it out to see if it helps you.
  • Descend feet first
    Studies have shown a Valsalva Maneuver requires 50 percent more force when you’re in a head-down position than head-up.
  • Look up
    Extending your neck tends to open your Eustachian tubes.
  • Use a descent line
    Pulling yourself down an anchor line helps control your descent rate. It also helps you stop your descent if you feel pressure.
  • Stay ahead
    Equalize often, trying to maintain a slight positive pressure in your middle ears. Don’t wait until you feel pressure or pain.
  • Stop if it hurts
    Your Eustachian tubes are probably locked shut by pressure differential. Ascend a little bit and try equalizing again.
  • Avoid milk
    Some foods, including milk, can increase your mucus production.
  • Avoid tobacco and alcohol
    Both tobacco smoke and alcohol irritate your mucus membranes, promoting more mucus that can block your Eustachian tubes.
  • Keep your mask clear
    Water up your nose can irritate your mucus membranes, which then produce more of the stuff that clogs.

 

Refresh your diving skills

Why would I need a scuba refresh?

Everybody has experienced it. You are on a diving excursion and one of your fellow divers is not at the level expected. It typically starts with the preparation of the dive kit. It takes ages to get prepared, requires the full attention of the dive centre staff and the person is obviously very nervous. Once ready, limited attention is given to the dive briefing. You now upfront this is going to be a hard one.

Having a good up to date knowledge and practice, handling of dive gear and understanding of diving procedures is key to fully enjoy your dives. Nevertheless we see divers in our centre regularly that are lacking at least one of these as they have not been diving for a while, regardless of the reasons, or do not feel confident. Besides the fact these divers increase the risks when taking them diving, they typically spoil the dives of the regular divers.

The same quite often applies for active divers that decided recently to make major changes to their dive equipment. Not sure how to use the new equipment or lacking practice with it, they easily shift the focus to the new kit as opposed to the diving while being under water.

When you recognize yourself in any of the above statement, it might be wise to talk to the dive centre and agree on a refresher course.

What’s in it for me?

Get back into it

Over time unused scuba knowledge fades. We as dive centre expect certified divers to safely plan and execute dives in accordance with their qualification. Planning a dive, controlling your bottom time, master your buoyancy and performing a correct safety stop are key to any dive. Understanding in-water safety procedures such as correct buddy procedures and what to do in case of diver separation are mandatory to conduct dives in a safe and controlled manner. During a refresher course we will go through all the steps of a dive and help to bring you back up to speed on all these aspects.

Understand and manage your own dive gear

Most dive centres require certified divers to assemble and disassemble their own dive gear, check and adjust your weights and make sure all is functioning correctly. A lot of attention on getting your dive equipment sorted out is given during the refresher session in order for you to fully master it.

Refreshing skills and routine

Any dive professional is ready to help you rehears the required scuba skills. Believe us, quite often small, forgotten things can cause major issues during a dive, ruining the dive for everybody. Sometimes they can even cause dangerous situations. Doing a refresher course allows you to rehears all the required skills thus reducing the risks of major issues afterwards. After the skill rehearsal you will start thinking as a diver again!

For the diver having changed his dive gear, these sessions allow you to build confidence in the use of your newly acquired gear while practicing with your instructor. He will be happy to help you out with any issue and even demonstrate how to use the equipment correctly.

Practice in a controlled environment

Scuba diving is not risk free and if something goes wrong, there is a risk attached. It’s critical for the safety of you and your dive buddy to know what to do if you find yourself in a low-on-air emergency situation. Strangely though, certified divers rarely practice these skills. Running through the skills under the supervision of an instructor allows you to practice them in a safe, risk-free environment so that they become more instinctive in the unlikely event something does go wrong.

Build confidence

As a certified diver you understand that being stressed for a dive is not the best option. When not having been diving for a while or you made some major changes in your dive gear, you will get nervous as you get closer to hitting the water. The higher your heart-rate gets, the more the stress will build up. This will have a negative impact not only on your air consumption, but might cause you not to react correctly on events during the dive. Practicing in a confined and controlled environment under the direct guidance of a pro will give you the confidence required and reduce the pre-dive stress. You will be able to fully enjoy the dive and reduce the risks for you and your fellow divers.

Get to know your guides

Quite often the pros assisting you during the refresher course are also the divers that will guide the dives. Getting to know each other and building report during the refresher course will help for the real dives. In addition these pros have tons of dives and know the environment you will be diving in by heart. Enjoy the refresher course to gather valuable information and get fully prepared to discover the underwater world at 100%.

Some final thoughts

All divers learn during their basic diving course, regardless from the agency, that a refresher is required when you did not dive for somewhere between 6 to 12 months. Experience teaches us that the person asking for a refresher course is often the least needing it. Quite some divers over estimate themselves and are confident a refresher course or even just a refresher dive is not required. Once they come into the centre and are requested to start preparing their gear we know how late it is. Please think twice before joining a dive and be critical on yourself, it will increase the safety for yourself, your fellow divers and your guides.

Regardless of the recommendations of the dive associations, each diver should make a critical evaluation of his ability to manage a dive end-to-end. Some divers may need some assistance to safely re-enter the water way sooner as others. The recommendations are just a rule of thumb but each should in the first place do an honest self-assessment. Believe us, as dive professionals we will not judge anybody requesting assistance to re-enter, just the opposite. At the end it is all about making sure dives are fun and enjoyable and can be conducted in the safest way possible.