• Aurora Team

Scuba diving ear equalization techniques

Ear equalization is simply opening the lower section of your eustachian tubes in order to allow air to enter. This is the same for all techniques, its just finding which variation works best for you personally.


Valsalva maneuver


The method most divers will learn as they start their diving adventure. Pinch your nostrils and blow gently through your nose. This works by overpressuring your throat, which usually pushes excess air up your eustachian tubes. Resulting in an equalized middle ear.


However, the Valsalva maneuver does have a few know issues.

  1. As it does not engage the soft palate muscle that usually opens the eustachian tubes, it is, therefore, unable to overcome an already locked tube under increased pressure.

  2. Can be hard to know exactly how much pressure to apply when blowing into pinched nostrils. Can result in damage by overblowing.

  3. The result of blowing against blocked nostrils actually increases your internal fluid pressure. This fluid pressure increase also includes that of your inner ear, increasing your risk of a ruptured "round window". Remember don't blow too hard and not to keep the pressure for longer than a 5 second period.

The safest methods of equalizing generally use the muscles of the throat to open the eustachian tubes in a natural way how that is closet to a natural equalization. Unfortunately, the Valsalva maneuver technique taught to most divers does not engage this muscle and rather works on forcing air from the throat to the eustachian tubes. This is fine if the diver keeps the eustachian tubes open for their descent through the pressure change as the head from the surface to depth. Or they are equalizing early and often enough in order not to have pressure closed Eustachian tubes., continuing with the Valsalva in this way can result in barotrauma injuries or worse blowing to hard or long and rupture the round or oval windows of the inner ear.


A couple of safer alternatives techniques for equalizing:


Voluntary tube opening


This is done by tensing your throat and pushing your jaw forward. Tense the soft palate muscle and throat while making a forward and down movement with your jaw, similar to the start of a yawn. The result is the muscles open the eustachian tubes. This method does, however, require a lot of practice, in due time divers can learn to control the mentioned muscles and are able to keep their Eustachian tubes open for continuous equalization.


Think of this practice similar to that of freediving, as you would do breathing exercises. Its a technique that will be very beneficial should you master, meaning full control with ease and much more happy descents for all your dives. As with all skills, practice makes perfect.


Tonybee Maneuver


Done by pinching your nostrils and swallowing. As you pinch your nostril or block them by the skirt of your diving mask skirt, simply swallow. Swallowing is the body natural way to open the eustachian tubes and therefore you are not forcing them open. As you have your nostrils closed and the when you swallow the tongues movement it compresses air against the tubes open. As they open the air flows to the middle ear.


A small note is that no one method is right for all divers, practice different techniques, and see what works best for your self personally. If you find you have difficulty equalizing during dives, we would recommend mastering several techniques. Maybe during your diving, you may need to try more than one method in order to comfortably and safely equalize. Some techniques are quite difficult to master, but unlike most diving skills, ear equalization is one skill you can practice anywhere. As alot of techniques require throat muscle use, we here at aurora wetsuits found that practicing in front of a mirror is very beneficial. This allows you to see the muscle movement and what is actually happening while doing each technique. Making it more understandable and visual.


Our tips for easy equalizing ears underwater


Listen for the "click"

Before your dive make sure that when you swallow you hear a faint "click" or "pop" in your ears. This is a good pretest that can give you an indication that your Eustachian tubes are able to open and allow for equalization. The day of your dive, practice your equalizing technique, this helps to reduce the chance of a block early on a descent. Also, another tip is to chew gum between dives and has been seen to reduce blockages on subsequent dives.


Descend feet first

As air will rise to the highest point, descending feet first increases the efficiency of equalization as air travels up your eustachian tube. Whilst liquid-like mucus will naturally work its way downwards. Studies have shown that a head down first descent requires around 50% more pressure in order to equalize using a Valsalva maneuver.


Lookup

As you look up the position of your neck naturally aids the opening of the eustachian tubes. Meaning an easier calmer descent.


Use a decent line

When descending if available, use the descent line if it allows. This way you control your descent much more by holding the line. Gives you more control of when and which depths you equalize while reducing the chance of rapid descent.


Stop if it hurts

If it hurts, stop! do not try to push through any pain. If you have pain this most likely means that your Eustachian tubes are locked closed from the increased difference in pressure. The only result by continuing will result in a barotrauma injury. Should you feel pain, stop! ascend slightly and try again to equalize.


Why we need to equalize our ears


Whilst diving we understand that there is a change in surrounding pressure as we descent and ascent. This change in pressure has an impact on our ears, requiring equalization in order to avoid any ear problems and injuries. Ear injuries are preventable with some precautions and being aware of how our ears are affected during a dive. During a dive, we need to ensure that our middle ear pressure is the same as our outer and inner ear pressure. This keeps the middle ear balanced and able to function as per normal. An imbalance of pressure is when you will feel pain and potentially a barotrauma injury.


L. Chittka; A. Brockmann - Perception Space—The Final Frontier, A PLoS Biology Vol. 3, No. 4. Vector by Inductiveload

As your inner ear is a dead air space, it is affected by the increased pressure as you descend into the depths of the underwater world. It is connected to the outer world only by the eustachian tubes which run to the back of your throat.


Failure to increase the pressure within the middle ear, to the same as the inner and outer ear s can result in a middle ear barotrauma injury. A middle ear barotrauma injury is the most common pressure-related injury in diving.


In order to make an efficient equalization we need to open the eustachian tubes of which are usually closed. Your eustachian tubes have a kind of one-way valve towards the lower part called a eustachian cushion. This acts as a safety barrier, preventing any unwanted particles entering from the nose. To open the tubes, in order to allow higher pressure air to enter from your throat to the middle ear section, usually requires a conscious response (action). Normally swallowing will be sufficient to open the tubes.


Equalizing your ears is not as difficult as sometimes made out. We do it several times a day subconsciously and without realizing it by swallowing. How come we equalize so many times per day you may ask? That is down to the fact that your middle ear is constantly absorbing oxygen which in turn is lowering the pressure within the middle ear. When you swallow your eustachian tubes are opened, this is done by the soft palate muscle movement. This allows air to transfer from your throat to your middle ears, equalizing the pressure. You can notice this happens when you swallow a faint "click" or "pop" that can be heard during the swallowing action.


Scuba diving increases the pressure change, putting more demand on the equalization system along with the need to counteract the faster change in pressure. As this is beyond what your natural system is designed to handle, you need to give it help in order to avoid any problems/injury.


Why must you equalize


If you dive without equalizing your ears you can experience pain within the ear leading to a damaging barotrauma injury in the middle ear.


Here is what can happen if you DON'T equalize correctly:


At one foot below the surface, your eardrums flex inwards and you feel the pressure within the ear. This is due to the fact that the surrounding water pressure at 1 foot is 0.445 PSI (pounds per square inch) more than at the surface.


As you reach a depth of 4 feet, the pressure difference has increased to 1.78 PSI. Your eardrums are now bulging into your middle ears. Along with the round and oval windows between the inner and middle ears. The nerve endings are therefore stretched and you begin to feel pain.


At a depth of 6 feet, the pressure has increased to 2.67 PSI, Your eardrums are now stretching even further. Resulting in eardrum tissues starting to tear. This can cause inflammation that can last up to a week. The small blood vessels at this point may even start to expand or break/burst. This creates bruising of the eardrum and can last up to 3 weeks, whilst your eustachian tubes will be locked closed by pressure. Making equalization impossible and pain to increase.


At 10 feet below the surface, the pressure is now at 4.45 PSI. If you made a rapid descent

for instance, your eardrums can break. Should this be the case water will flood the middle ear. At which point you will feel the sensation of the cold water coming against your balancing mechanism. In turn, can this can cause a sense of vertigo, especially if only one eardrum has burst. Dizziness and the feeling of disorientation as the world spins around you can happen very fast at this point. However, this will stop as your body warms up the water within your middle ear. Another issue could be on a more gradual descent and you try to equalize by blowing hard and long against a pinched nose (nostrils), you can rupture your round window membrane between the middle and inner ears. Known as inner ear barotrauma. Results in Perilymph fluid draining from your cochlea into the middle ear. Temporary or sometimes permanent hearing loss may be a result.


This shows why we should always make a slow, steady, and controlled descent on all dives. Regardless of experience or dive numbers, we are all susceptible to ear problems.


When to equalize


Now that we covered what happens under pressure to our ears, along with a few different methods. We need to know when to equalize on your dive. It's actually sooner and more often than you would expect. Most diving organizations recommend equalizing your ears every two feet of your descent. Whilst at a slow descent of 60 feet per minute, meaning you should equalize every two seconds. A lot of divers descend much faster and should be constantly equalizing as a result.


The deeper we go the less often we need to equalize and this is due to Boyles law. If you were to descend to 6 feet, your middle ear air space would compress by 20%, producing pain. But if you look for the same 20% compression difference from 30 feet you would have to descend to 42.5 feet to have the same compression of 20%.


One keynote to take into account also that many divers do not do is equalizing at your final depth. This is because the pressure difference can be minimal, meaning we cannot feel it. But over several minutes this can gradually cause barotrauma. So remember to equalize again once at your maximum depth.


We do hope this view of equalization has helped you in your search for new ideas and/or understanding in regards to how to equalize on the descent. We also recently covered a section on different types of ear problems when scuba diving if you are interested find out more.