Scuba diving and ear problems: Part 1

Joseph R. Anticaglia MD
Medical Advisory Board

Last year In the U.S, more than 3 million people participated in scuba diving, a sport that is enjoyed by both sexes in all age groups. Recreational scuba diving is popular and world- wide with more than 23 million scuba diver certifications issued in 2015. However, its growth in popularity has been accompanied by an increase in the number of ear complaints associated with this activity. (1), (2)

What does Scuba mean?

SCUBA is an acronym for “self-contained underwater breathing apparatus.” Self-contained means that divers transport their own supply of oxygen and nitrogen in a cylinder not connected to the surface which allows them to breathe and move more freely underwater.

What is Ear Barotrauma?

Barotrauma means injury to your body because of changes in the ambient pressure, i.e. pressure on the outside of your body compared to the pressure on the inside of your body, for example, the air spaces in the middle ear.

When you’re in an airplane, the ambient pressure on your body is air (barometric); when scuba diving it’s water.

The pressure outside the body is increasing if you’re in an airplane that is landing or if you’re descending while scuba diving. On the other hand, the pressure outside the body is decreasing if you’re going up in an airplane or going up returning to the surface after scuba diving.

This article focuses on ear barotrauma, although the lungs and other parts of the body may be affected with barotrauma.

What are the Symptoms of Ear Barotrauma?

Ear symptoms are the most common complaints of scuba divers. The symptoms are listed below.

  • Ear pain “ear squeeze” — a frequent complaint of divers
  • Ear fullness
  • Fluid or blood behind the eardrum
  • Perforated eardrum
  • Loss of Hearing
  • Dizziness — Vertigo
  • Unsteady gait — off balance
  • Tinnitus — ringing in the ears (3)

What Causes Ear Barotrauma?

If you looked at the ear with an ear instrument you’ll notice the eardrum. The Eustachian tube (E-tube) is located behind the eardrum in the middle ear. The E-tube is the opening that connects the middle ear to the upper part of the throat behind your nose. It’s about one and a half inches in length and the opening is about the width of the lead in a pencil.

The E-tube “pops” open when we swallow or yawn to allow air to enter the middle ear equalizing the pressure inside and outside the eardrum. To prevent ear problems, the pressure inside the eardrum should be about equal to that on the outside of the eardrum.

The E-tube doesn’t work well when it is subjected to rapid changes in the ambient pressure, which can happen during scuba diving. The difference in pressure between the outside and inside of the eardrum causes ear pain, the most common complaint of divers. The ear pain or “ear squeeze” is more severe compared to the one airline travellers’ experience. The E-tube dysfunction can lead to other symptoms as noted above. (4)

External, Middle and Inner Ears

The most common medical diving problem is middle ear barotrauma. Divers complain most often of ear pain and blocked ears. Divers often experience these problems near the surface of the water, at shallow depths between 3-9 feet. The deeper the diver descends in water, however the greater is the pressure around the body and the greater is the probability of rupture of the eardrum.

Though less common when compared to middle ear problems, the ill effects of inner ear barotrauma can result in tinnitus, loss of hearing, dizziness, vertigo and an unsteady gait. This problem most often occurs from a diver’s descent (compression) in contrast to Decompression Sickness see below,

The external ear canal is ordinarily filled with air. Wax, bony growths in the ear canal or ear plugs can block the ear canal, As the diver goes deeper in water, the eardrum can bulge outward causing pain and small blisters on the eardrum.


The diagnosis is based on medical and diving history. After surfacing, the diver might complain of ear pain, loss of hearing, tinnitus or dizziness. Examination of the ear, a hearing test or a test for dizziness might be needed. A note of caution, inner ear barotrauma needs to be distinguished from decompression sickness…

Part 2 will discuss Decompression Sickness, Treatment and Prevention.


  1. Glazer, Tiffany A.; Telian, Steven A.; Otolologic Hazards Related to Scuba Diving; Sports Medicine, online February 8, 2016.
  2. Young II Lee; Byeong, Jin Ye; Underwater and Hyperbaric Medicine as a Branch of Occupational and Environmental Medicine; Annals of Occupational and Environmental Medicine December 19, 2013
  3. Azizi, MH; Ear Disorders in Scuba Divers; International J. of Occupational and Environmental Health, Jan. 1, 2011
  4. Anticaglia, Joseph R,; Airplanes and Ear Problems; HC Smart, June, 2016
  5. Orr, Dan; Douglas, Eric; Safety Scuba Diving; April 25, 2007.
  6. DAN, Divers Alert Network; Emergency Telephone Line (919-684-9111).
  7. American Research Hearing Foundation; Barotrauma.

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.