Ear pain is the most common complaint from scuba divers and is
experienced by almost every diver at some point. Some divers call it
ear squeeze. The pain occurs because of differences in pressure between
the middle ear and the outside environment.
Ear pain occurs during the descent portion of a dive as the diver drops deeper underwater. As the diver descends in the water, water pressure increases on the external surface of the ear drum (tympanic membrane). To counterbalance this pressure, the air pressure must reach the inner surface of the ear drum. To do this, the Eustachian tube will open and allow the pressure behind the eardrum to equalize with the outside pressure of the seawater in the ear canal. But, if the Eustachian tube can't open, then as the seawater pressure in the ear canal increases, the eardrum is forced inward, inflaming the eardrum and causing pain. If the pain is ignored and the diver drops deeper, the pressure will continue to increase and the eardrum may burst (rupture). Cold seawater will then rush into the middle ear causing nausea, vomiting, and dizziness.
There are many reasons that the Eustachian tubes may not open to equalize the pressure.
Pressure against the eardrum is responsible for the symptoms of ear squeeze. At low pressure, the diver has a feeling of fullness. As the pressure increases, the eardrum bulges inward, swells, and becomes painful.
Continued high pressure can rupture the eardrum. If this happens, air bubbles may be felt coming from the ear and the pain may lessen. Cold water then enters the middle ear through the hole in the eardrum. The diver may become nauseated or vomit. The diver may also become disoriented or have a sensation of spinning (vertigo).
Upon returning to the surface, the diver
may feel fluid draining out of the ear if the eardrum has been ruptured. Rarely, a one-sided facial paralysis may be associated with ear squeeze.
The majority of cases of ear pain or squeeze force the diver to abort the dive before the eardrum ruptures. In these cases, symptoms often resolve shortly after the diver reaches the surface. If symptoms continue or the cause of the ear pain is not known, seek medical care. Disorientation, vomiting, and hearing loss are symptoms of a ruptured eardrum and require medical care.
If a ruptured eardrum is present or suspected, the diver should be
evaluated in a hospital's Emergency Department. Transport by car is
acceptable. No further dives should be undertaken until the diver is
medically cleared.
The treatment of ear squeeze begins during the dive. If a diver feels fullness or pain, stop the dive and attempt to clear the ears. If ear clearing techniques fail, the dive must be ended. Always complete the decompression stops if necessary when returning to the surface.
If the eardrum ruptures, the diver may become disoriented or vomit,
which may lead to panic. Panic may lead to ascending too rapidly. The
diver's partner (dive buddy) should carefully observe and assist during
the ascent. On the surface, keep the ear dry. Do not place anything in
the ear.
The most important treatment was done by aborting the dive and ascending to the surface, making any necessary decompression stops.
Prevention is the preferred treatment for ear squeeze.
