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Protect your ears as the pressure builds: Barotrauma and other ear problems

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By: Gemma Smith

When you ask people who don’t dive what they think the most common type of diving injury is, the answer is usually ‘The Bends!’. If not this then at least an imagined tale of a Jaws-type marine monster attacking innocent divers one by one. The real answer is actually a lot simpler, and significantly less Hollywood. The most common injury you will encounter as a diver over a lifetime will be related to your ears.

The ears are an incredibly complex piece of our bodies. It is important we understand how to protect them. To do this, we need to first have a basic understanding of how they work. In very simple terms, the ear is actually formed from three areas: the outer ear, middle ear, and inner ear.

Outer Ear

The outer ear is what we see in ourselves and each other when we think of ‘ears’. It is made up of two parts, the pinna, and the ear canal.

Pinna

The pinna is the cartilaginous, flesh-covered flap located on each side of our heads. While the ear is incredibly multifaceted and involved, most of the clever design features are located internally. The pinna is actually the only part of the ear which is externally visible to us. Its job is simple but vital: to collect sound waves and channel them down the external ear canal. It also channels water into and out of the ear. Its cleverly engineered shape is not for nothing. Sound waves that are approaching us from behind are partially shielded by this outer fleshy area. This helps us to better determine the location the sound has come from. This is what helps us judge whether the origin of the sound is from behind or in front of us.

Ear canal

The ear canal is just a few centimetres long in adults and has a slight S-curve to it. The outer portion of the ear canal is covered by a thin layer of skin containing glands. These glands are responsible for the production of earwax. Thin hairs are also found covering the skin near the ear canal. It is this dynamic duo of tiny hairs and ear wax that is crucial in catching airborne particles. Dirt and detritus are caught before they have a chance to reach the middle and inner ear.

The Middle Ear

Following the twisting ear canal inwards leads us to the eardrum, more technically known as the tympanic membrane. It is this membrane that separates the middle ear from the outer ear. Within this middle ear are located the body’s three smallest bones – the malleus, incus, and stapes. As divers, this is the area we are most concerned with. It is this air-filled chamber that is more likely to give us trouble than anything else over the course of our diving life. Connecting our middle ear to the back of the throat are the Eustachian tubes. These little tubes allow us to keep the pressure between the middle ear and the outside environment equalised. This prevents any pain or discomfort from occurring. The underwater swallowing or yawning we see divers do is to allow this equalisation to occur.

The Inner Ear

Last, but definitely not least, we come to the inner ear. This is the part of the ear deepest within our bodies. Within the inner ear is the cochlea. This is the part of the ear actually responsible for hearing. It converts the vibrations from sounds into what we eventually hear. The cochlea is also noteworthy as it contains fluid-filled chambers. This can cause serious issues if any rupturing were to occur. The seeping of fluid from the inner ear to the middle ear is not something any diver would ever want to risk happening. Aside from the obvious discomfort, anything that causes us to feel dizzy or disoriented underwater is downright dangerous. This is just one of several reasons why you should never ever force equalisation to occur.

So now we understand all the main different components that make up our ears. From here we can start to look at the best ways to protect them. Diving puts us in a physically very different environment than the land-based one we are used to. By being aware of the risks and differences in this new world, we can greatly limit any possible issues that may occur. Let’s look at a few of the most common ear problems we may encounter when submerging:

Barotraumas

When we descend under the water, the most physically obvious difference to a diver is, of course, the pressure change. As we sink, the pressure of the water surrounding us increases. Any time the pressure around us changes, the chance of a barotrauma occurring rears its ugly head. Very simply, a barotrauma is any kind of pressure injury (baro comes from the Greek word for ‘pressure’, and trauma means ‘wound or injury’). If we don’t equalise as we go down then the pressure surrounding us increases while the pressure within our bodies stays the same. This causes an imbalance between the outer ear and the air filled chamber of the middle ear.

By gently pinching our noses and blowing, wiggling our jaw from side to side, or even just swallowing, we open our Eustachian tubes. As mentioned earlier, these tubes provide a direct link from the back of our throats to our middle ears. They are what allows us an easy equalisation of pressure. If we don’t do this, not only will it be painful, but we increase our chances of rupturing our middle ear with this pressure imbalance. Middle ear barotraumas are the most common injury in diving. They are also one of the easiest to prevent. Remember the golden rules:

  • Equalise carefully on the surface before you even start to descend. Continue gently equalising every meter/few feet of your descent. This is especially important when shallow and the greatest pressure differences are occurring.
  • Although most people learn the Vasalva technique when they first learn to dive (where you gently exhale against your pinched nose), it isn’t the right fit for everyone. There are other equally valid methods out there to allow you to equalise. Look at the Toynbee Maneuver (where you pinch your nose and swallow) or Frenzel Maneuver (where you pinch your nose and make the sound of the letter ‘K’). Don’t be afraid to try them if the Vasalva is just not working for you.
  • If you are struggling to equalise as you descend try rising a little and trying again. This lessens the pressure slightly and may be all you need to allow you to continue a slow and controlled descent. Some people also find that descending in a more feet down position allows for an easier equalisation.
  • Never ever force it.
  • If you have a cold of any kind give the dive a miss. Do not think decongestant will solve the problem. It is worth remembering that while most pressure injuries with ears occur on descent, there is also a pressure change when we ascend at the end of a dive. This is one reason to be very wary of taking any decongestants before submerging. The effects will most likely wear off before the end of your dive, and you will still need to ascend regardless. If the Eustachian tubes are now blocked then the expanding air in your middle ear, caused by the now lessening pressure on ascent, has nowhere to go. This is a reverse block, and can have painful consequences.
  • Without wanting to be the party-pooper in the room, smoking and alcohol are not good for you in any way as a diver. With regards to equalising, both of these things can irritate your mucus membranes. This can cause a blocking of your Eustachian tubes. Interestingly, for those of you having problems with your ears, consider cutting down on your dairy intake. Milk has been shown to increase the production of mucus. This may well be affecting your ability to comfortably equalise.
  • If you have any pain or discomfort in your ears after the first dive give any planned second dives a miss. There will always be more diving days in the future. Healthy ears are not so easily come by, nor damaged ears that easily fixed. If the pain or discomfort persists after the dive it is worth getting it checked out by a doctor. The peace of mind of knowing that everything is good with your ears is worth the time taken!

Infections

Ears are funny, twisty, labyrinthine parts of our bodies. As such they are sadly prone to detritus lodging in them. This is one cause of ear infections. While not always specifically a diving related problem, it is one that can be exacerbated by in-water time. Otitis Externa, for example, is an outer ear infection. This is generally caused by frequent time in the water. The water causes the cells which line your ears to swell slightly. This can create an opening for opportunistic bacteria to enter. Here they find a warm, damp, welcoming place to multiply. Left untreated this can cause pain and swelling all along the jawline.

Realistically, infections are something you want to get sorted as soon as possible. As someone who has, sadly, had several ear infections over the years, I can attest to the extreme discomfort one feels with such an infection. Luckily it’s usually an easy fix, with ear drops prescribed by a doctor clearing up all but the worst cases. If not then antibiotics may be required. It does, unfortunately, mean it is more prudent to stay confined to dry land until it is all sorted.

All of us have ear problems from time to time. If you are finding that constant equalisation or pain issues are regularly preventing you diving though, think about going to see a specialist. A doctor focusing on possible ear, nose, and throat (ENT) troubles may well be all you need to figure out what your body is not liking about your current regime. There are also various devices available now, such as masks which cover your ears as well as your eyes and nose. With tubes connecting all the air pockets so you can still equalise, this keeps water out of your ears and minimises infection risks. Never risk your ears, but, as with most things in life, there is normally a way around most problems. Take the time to speak to experts and look at possible lifestyle changes.


To find out more about International Training, visit www.tdisdi.com.

From its humble beginning in 1994 to today, the group of training agencies Scuba Diving International (SDI), Technical Diving International (TDI), and Emergency Response Diving International (ERDI) form one of the largest diving certification agencies in the World – International Training. With 24 Regional Offices servicing more than 100 countries, the company today far exceeds the original vision the founders had when they conceived the idea on a napkin, sitting at a kitchen table in the early 1990’s.

Dive Training Blogs

Tips for… Choosing Equipment

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We are divers…we all love the nice new shiny dive toys right?! But, how do we choose what is best to get? The best brand or because it’s orange? In our experience, we suggest that ultimately it comes down to what you are going to use it for.

Each year we have divers come onto our dive boat or for shore diving with their light fins that are perfect for the Red Sea, but end up with their feet in the air in a drysuit; and their regulators which are not cold water rated ultimately ending up in free-flow. So, our first suggestion with equipment is to not only consider the purchase based on what your current diving entails, but consider your future aspirations.

This does not just relate to warm water and cold water diving, but what you may consider in the future in relation to specialities. Will you be looking to progress into Advanced diving and using Nitrox? Then purchase a dive computer with this capability. It is easy to jump into buying dive equipment just because we want it now! But take a moment to consider your future diving journey.

I guess the next question that we get asked all of the time is what to buy? What items as a new diver should we get? Admittedly what we suggest and what others suggest will vary, however our personal suggestion is to get your own mask and dive computer. An ill-fitting mask will make your diving far from enjoyable and so this should (in our opinion) be a first for all divers, and a dive computer – well, we all want to start logging our dives!

Not only that, but these are two items you can take with you anywhere in the world… easy to pack into your suitcase and not specific to a local area. Getting these two items start your equipment purchase journey but also gives you the time to try the other items such as regulators and BCD’s and see what best works for you.

The last tip of ours in relation to equipment is… don’t rush into buying and buy what YOU want. Just because someone else has it, does not mean that it will work for you. If you want a red framed mask yet the store only has yellow, wait for the red to come on order. If you purchase correctly, you can most definitely have these same items for a number of years, especially when looked after correctly. Get it right the first time and save yourself the headache of extra expense in the future.


Find out more at www.duttonsdivers.com

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Dive Training Blogs

Jump into… Starting a charity

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As if having two dive centres and Scuba Escape was ‘not enough’, I also decided, last year, to set up a charity for mental health in diving. Why? Because it seemed as though it was not just my personal experience demonstrating a need for this. Some of you may or may not be aware of certain issues that prevailed in the previous year, what you do not know are the stories from the previous four years before that. We can leave that conversation for another time though!

We usually see diving as a way to improve our mental health, at least I hope that is the case for most of you. A minority of others, despite loving the activity, are subject to bullying within our industry. Don’t just take my word for it. From a survey completed by over 250 of you in the UK, 72% of you said that you had either been bullied, or witnessed bullying. 62% said that this still exists. A scary thought for our amazing industry. 

So what are the actual issues? Many of you stated that the bullying related to agencies or equipment, a person’s size, gender and age were also focal points within the survey. All things that have no bearing on us undertaking Scuba Diving at all. This presented the need for the charity. People completing this survey had stated that they remain with these individuals or organisations because they have nowhere to go, yet want to dive; others also stating that they stopped diving altogether because of having no other place. That then became the idea for the ‘Just Scuba Charity’, which is, as it says, Just Scuba. No politics, nobody caring what equipment you are using… Or what size your drysuit is… just diving. 

The charity will be starting up this year as I have been waiting, and successfully obtaining, charitable status. We will be asking for divers wishing to volunteer as ‘dive buddies’ that others having personal issues with their mental health in diving can come to, and just dive. To find a new network of friendly, non-judgemental people to share their passion of the water. Other aspects of the charity will include mental health support options for divers to access, information on how to respond to bullying, to challenge the behaviour or report it, and for those feeling like they have nowhere to turn, a contact email and chat to access support. 

Whether you have been affected by bullying within diving or not, unfortunately it does exist and now is the time for us all to come together and stand up to this, to protect our diving community. 

If you have not yet checked out the charity, please visit www.thejustscubacharity.org


Clare began Duttons Divers at just 19 years old and a short while later became one of the world’s youngest PADI Course Directors. Find out more at www.duttonsdivers.com

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