EAR PROBLEMS WITH DIVING

Fred Bove, M.D., PhD. There are several parts of the ear, each of which has a unique set of diving related disorders. The external ear includes the ear itself, and the external canal leading to the ear drum. The ear drum separates the external from the middle and inner ear.

EXTERNAL EAR PROBLEMS

The ear structure can be injured by trauma. Feeding fish underwater sometimes invites a nip on the ear by a dissatisfied “customer.” Occasionally, a fish bite becomes severe enough to require treatment.

Swimmer’s Ear

External ear canal infections, sometimes called “swimmer’s ear”, occur when water accumulates in the external ear canal, and remains long enough to allow bacteria and fungus to grow. Prevention of external infections is best done by using Otic Domeboro solution. A few drops in each ear before and after water exposure are adequate. Excess wax in the ear canal can also cause water retention and lead to an infection.

MIDDLE EAR PROBLEMS

The middle ear includes the chamber situated behind the ear drum, which contains the small bones of the ear that transmit sound to the hearing organ. Connected into the middle ear is the Eustachian tube from the throat which is necessary for pressure equalization, and the mastoid cells which are spaces in the bone of the skull. The middle ear is easily injured by barotrauma (squeeze), and is susceptible to infection. The diagram shows the structures of the ear.

Ear Squeeze

Ear squeeze with injury to the ear drum, is the most common diving related illness. To avoid ear squeeze, be sure there is no congestion in your nose or throat when you dive. Begin clearing your ears on the surface before you descend, and continue to clear every foot or two as you go down. Waiting for ear pain to occur before you try to equalize is a bad habit. Usually you cannot clear the blocked ear at this stage.

Besides causing direct injury to the ear drum, middle ear squeeze produces swelling of the lining of the middle ear and Eustachian tube. Often fluid will persist in the middle ear until the swelling has subsided and normal Eustachian tube function returns. When a squeeze occurs, there is some damage to the ear drum, and occasionally the eardrum will rupture. If the damage is severe, and ear problems persist for several days after diving, medical attention should be sought. Most middle ear squeeze can be successfully treated with medication, but you should not return to diving until the ear is completely clear.

INNER EAR PROBLEMS

The inner ear consists of the hearing(Auditory) and balance (Vestibular) organs, and their nerve connections to the brain. The inner ear is connected to the spinal fluid space, and when injured, can allow infection to spread into the brain. The inner ear is separated from the middle ear by the round and oval windows. Injuries to the middle ear include round window rupture, inner ear decompression sickness and vestibular decompression sickness. Scroll up to see a diagram of the ear.

Round window rupture

A more serious barotrauma injury related to diving is rupture of the round window (RWR). You can cause RWR by forcefully trying to equalize during descent. By doing a Valsalva maneuver to equalize, you raise the pressure in the inner ear above ambient pressure. If the Eustachian tube is blocked, the middle ear pressure will be below ambient, and the large pressure difference can blow out the round window. When the round window tears, fluid from the inner ear leaks into the middle ear. When fluid is lost, hearing is lost, Vertigo occurs, and hissing or buzzing is heard constantly. The tear in the RW can heal itself, but often surgery is needed to correct the problem.

Inner ear Decompression Sickness (DCS)

Rarely DCS can occur in the inner ear and cause permanent hearing loss or permanent abnormalities in balance. This injury is characterized by sudden total hearing loss in one ear following a dive. Inner ear DCS usually occurs in commercial divers after deep saturation diving. One case of suspected inner ear DCS was recounted in a sport diver, but considering the larger number of sport divers and the questionable diagnosis, there should be no concern for inner ear DCS in sport diving. If other symptoms, such as hearing loss, vertigo, dizziness, or loud roaring or ringing noises are present, you should seek prompt consultation with an ENT specialist.

PREVENTING EAR INJURY

You should learn the various ways to clear your ears. If you still have trouble after using the correct method of clearing, have an ear, nose and throat exam by a doctor who knows diving medicine. Protection of your ears during diving requires careful attention to the health of your nose and throat, and to your techniques of descent and ascent.