Let’s face it: ears and water don’t always get along. Going for a swim commonly causes water-clogged ears, and diving can throw off your ear pressure. However, that likely won’t stop you from exploring the deep sea. If you’re going diving, make sure you know how to equalize your ear pressure while underwater and afterward.
For divers, equalizing ear pressure is essential. If you don’t, you may experience discomfort related to barotrauma. Barotrauma occurs when a sudden change in pressure (either water or air) affects the body.
Ear pressure usually matches that of surrounding water or air, but when there’s an imbalance, you may experience dizziness, pain or a feeling of fullness in your ear(s) and slight hearing loss. In more serious, long-term cases, you may experience notable ear pain, pressure in the ear, moderate to severe hearing loss or even a nosebleed. Much of these symptoms can be avoided by equalizing ear pressure.
If you’ve ever heard that “popping” noise and felt the relief of your ear pressure equalizing, thank your Eustachian tube. This part of the ear that helps equalize pressure is located in the middle ear and connects it to the back of the throat. When your body experiences a change in pressure, the tubes must open to equalize it.
By yawning, chewing or swallowing, you engage two muscles—the tensor veli palatini and the levator veli palatini—connected to the Eustachian tubes. The contraction of these muscles causes the Eustachian tube to open and let in air.1 Then, you’ll likely experience that “popping” sensation in your ear and your ear pressure will adjust, offering relief.
There are many ways to mitigate and prevent the uncomfortable effects of unequal ear pressure. Before going underwater, it’s important to know how to equalize ear pressure when diving. Certain methods are suitable for freediving—a style of diving in which you hold a single breath, go underwater and return to the surface as needed—while others are ideal for scuba diving with its associated equipment. We’ll explore several of these options below.
The Frenzel maneuver, suspected to be the most popular ear pressure equalization methods, is quite simple.
First, close your mouth and pinch your nostrils, then try to make the sound of the letter “K.” This method can be hands-free if you use a nose clip.
You can use the Frenzel maneuver for freediving, and it’s easy to repeat until the pressure in your ear subsides.2
Find more detailed step-by-step guidelines later in this blog.
To do the Valsalva maneuver, close your mouth and pinch your nostrils shut. Then, try to exhale through your mouth as if you were trying to blow up a balloon. Use some force while doing so, but be cautious not to overdo it.
If it’s done too aggressively, the Valsalva technique can potentially cause certain ear ruptures.2 Both scuba divers and freedivers can use this method, though it may be an inefficient option for some freedivers.
The Valsalva and Toynbee maneuvers are a little different from each other.
For the Toynbee maneuver, you again start by closing your mouth and pinching your nostrils. Instead of making a “K” sound, you’ll swallow deeply.
This swallowing will cause the muscles connected to the Eustachian tubes to contract, again allowing air to flow through the tubes and equalize the pressure. Due to the swallowing and pinching of the nose, this option may not be ideal for freedivers.
A notably safe method, voluntary tubal opening requires a bit of practice.
It involves tensing the very back of the roof of your mouth—known as the soft palate—and the muscles in your throat. Keep your mouth closed as you do this, and push your jaw forward and down. It’ll feel like you’re yawning, sans the open mouth.
By tensing and screeching these muscles as you move your jaw, you’re opening up your Eustachian tubes and letting air through. Given you don’t need to use your hands, voluntary tubal opening is popular among freedivers.
Here’s how to do the Frenzel maneuver step by step:
The Valsalva and Frenzel maneuvers are said to have similar effectiveness.2 The Valsalva maneuver, compared to the Frenzel, requires a bit more caution to prevent any damage to the ear. On the other hand, the Frenzel can be done quickly and repeatedly without much effort. Between the two, determining what works best depends on the individual and their preference.
Before you dive in, first things first: test your ears. You’ve already put on your suit, equipment, goggles, etc., and now you have to make sure you can clear your ears. Then, once you go underwater, check again for good measure before committing to the dive.
It’s important to equalize ear pressure as you go—about every two feet of descent—to avoid any related discomfort. At a slow rate of descent, such as 60 feet per minute, you need to equalize every two seconds. It’s even more frequent if you’re a faster diver. Be sure to take the time to do one of the aforementioned methods, and do so frequently. Going too deep without adjusting will “lock” your Eustachian tubes and prevent them from popping, due to the pressure difference between the ear and water.
If you dive without equalizing ear pressure, you may experience unpleasant symptoms including pain and/or bleeding in the ear, dizziness and inability to resolve the pressure buildup. Learn more about these risks and how you can prevent or resolve them below.
As you dive deeper underwater, you should not feel pain. If you are, your ears likely aren’t equalizing properly. While diving, it’s important that you stop descending deeper if you cannot equalize ear pressure. Ascend as needed until the aforementioned methods work again, and if you are still unable to equalize ear pressure, return to the surface.
Often, congestion can interfere with pressure equalization. Before diving, consider these questions:
All of these things can cause an increase in mucus or irritate your mucus membranes, making it hard to equalize ear pressure.
Here are a few more important ways to prevent being unable to equalize ear pressure:
As we’ve covered, barotrauma occurs when a sudden change in water or air pressure affects the body. Ear pressure usually matches the surrounding water or air, and when they’re not equal, you may experience dizziness, nausea, vomiting, pain or a feeling of fullness in your ear(s) and slight hearing loss.
You can experience this—known specifically as ear barotaruma—when first going underwater and if you do not equalize ear pressure regularly while diving.
Though rare, long-term hearing issues related to diving are possible. Usually, they’re due to damage from ear barotrauma or inner ear decompression sickness, which occurs following significant pressure exposure. Most physicians would recommend forgoing diving if you experience ear damage, as it could worsen hearing loss.
If you’re experiencing ear pain or an inability to equalize ear pressure while diving, speak with a hearing care professional to ensure your ears are in top shape.
1 Casale, Jarett, et al. “Physiology, Eustachian Tube Function.” StatPearls, U.S. National Library of Medicine, 17 Mar. 2023. https://www.ncbi.nlm.nih.gov/books/NBK532284/.
2 Wolber, Philipp et al. “Prospective study on the Eustachian tube function during Frenzel maneuver in a hypobaric/hyperbaric pressure chamber.” European archives of oto-rhino-laryngology, affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery vol. 279,4 (2022): 1843-1850. doi:10.1007/s00405-021-06888-1. https://doi.org/10.1007/s00405-021-06888-1.
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