Scuba diving, ear problems and barotrauma: Part 2

Joseph R. Anticaglia MD
Medical Advisory Board

Part one discussed barotrauma, symptoms of ear barotrauma and diagnosis… Part two continues with Decompression Sickness…

Decompression Sickness DCS (Caisson Disease — “The Bends” — Decompression Illness)

According to a report by Dr. E.D. Thalmann, DAN Assistant Medical Director, DCS describes a condition “that happens to your body when you’re surfacing after a dive. It occurs in approximately 1,000 U.S. scuba divers each year. It affects scuba divers, aviators, astronauts and compressed-air workers.”

The atmosphere is mainly composed of 78 % nitrogen and 21% oxygen. As a diver descends underwater, the pressure around the body increases. This activity forces and compresses nitrogen into the tissues of our body.

The problem arises if the diver executes a rapid ascent to the surface. This can result in DCS, the release of nitrogen bubbles into the blood and other tissues of the body. If the bubbles enter the blood stream, there is the danger of a gas embolism To prevent DCS, the diver must ascend slowly to allow nitrogen to slowly exit from the tissues in the body.

DCS is more common with military or commercial divers with complaints of pain in the joints and limbs. But with this sickness, the inner ear might be involved with symptoms of hearing loss, tinnitus, or dizziness which resemble inner ear barotrauma.

Inner ear barotrauma occurs when the diver is descending in water. In contrast, DCS happens when the diver is ascending towards the surface. After scuba diving, DAN (5), (6) recommends you wait at least twelve hours before boarding a plane to prevent DCS.


For external ear barotrauma, remove wax and any other obstruction from the ear canal before the next dive.

For middle ear barotrauma, perforations, ear fullness ringing in the ears often resolve on their own. Decongestant medication or steroid nasal sprays can be used in an attempt to treat E-tube dysfunction. If a problem persists, or when in doubt, consult a physician to manage the situation. Antibiotics may be necessary if there’s a hole in the eardrum or infection of the middle ear.

A diver with hearing loss, vertigo or balance problems secondary to inner ear barotrauma needs to be examined in the E.R. and might need hospitalization to treat the problem.

When a diver or other worker such as a miner suffers from DCS, basic life support emergency treatment should be initiated including the administration of 100% oxygen and the use of intravenous fluids for these patients

Arrangements should be made for recompression therapy, namely, hyperbaric chamber treatment. This treatment involves breathing pure oxygen in a pressurized room or tube and should be initiated as soon as possible.


  • Breathe normally throughout the dive
  • Ascend slowly
  • Complete your decompression stops
  • Know your limits
  • Keep physically fit
  • Stay within a healthy weight range
  • Be adequately hydrated
  • Don’t drink alcohol before or after diving
  • Don’t exercise within 12 hours of diving
  • Don’t dive if you have serious medical problems
  • Treat nasal congestion with the appropriate medication
  • Get the proper training and certification
  • Use the right equipment that’s in good working order.


Ear pain — ear squeeze — is the most common complaint of scuba divers. Other complaints range from outer ear infection to short bouts of ear fullness to permanent loss of vertigo requiring hospitalization. Here are some more takeaways.

  • Don’t dive if you cannot clear (“pop”) your ear.
  • Don’t dive if you have nasal congestion, for example from a cold or allergy.
  • Don’t dive if you cannot equalize the pressure (descending in water or ascending to the surface)
  • Finally, if you have an emergency you can call DAN. (6) Better, get certified for basic first aid or consider taking a course in CPR.


  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.