Recently, DAN AP has had a couple of cases of novice divers experiencing problems equalising leading to Ear Barotrauma:
Case 1
A 28-year-old female had completed her Open Water Course Dives the previous days. The first day she completed two dives to a maximum depth of 12m with no problems. On Day 2 her first dive was to 17m for 41 minutes. She completed a 3.5 hours surface interval then undertook a second dive to 18m for 42 minutes. She completed safety stops on both dives. She had trouble equalising, including pain, during dives three and four. After diving she had ear discomfort. She woke up the next day dizzy with yellow blood-stained discharge on her pillow. She was complaining of dizziness, nausea and reduced hearing in her right ear, with no pain or tinnitus (ringing in the ears). She saw a local doctor who could not see her eardrum due to the discharge but diagnosed an ear problem. No medication was given. She also had tingling on both legs and arms and noted weakness.
Diagnosis: Ear barotrauma; possible DCS.
Case 2
Male diver with a history of only 13-dives. He had dived the previous day and experienced equalisation problems. He woke up with ringing in his ears but continued to dive that day and still had ringing in his ears but no pain, nausea or dizziness.
Diagnosis: Ear barotrauma.
Comment by DAN’s John Lippmann
The common denominator in these cases is that both individuals are novice divers.
Although one of the first skills divers learn is how to equalise their ears it is very common for new divers to have trouble equalising their middle-ear spaces. As you gain experience and learn the techniques that work best for you, equalisation generally becomes easier. Failure to adequately equalise the ears results in ear barotrauma (pressure injury), and is generally accompanied by a feeling of pressure, soon followed by pain, during descent (or sometimes ascent).
The most common and usually the most effective method of equalising involves the diver holding his/her nose and blowing gently. This is known as the “Valsalva Manoeuvre”. Although this method is very effective, damage can occur if it is done too vigorously. Overly-forceful equalisation should be avoided. Other methods include swallowing (with or without the nose blocked), wriggling the jaw, squeezing the tongue against the soft palate, or a combination of these. Divers need to ensure that whatever technique they use is effective in preventing pressure build-up.
If the pressure is not equalised, swelling and bleeding of the lining within the ear will occur, which helps to equalise the pressures and relieve the pain, although this can often lead to infection. In some cases, the eardrum can rupture and, in very severe cases, delicate membranes within the inner ear can tear, enabling fluid to leak from the inner ear and creating the potential to damage this delicate organ, possibly affecting hearing and balance.
Bubbles from decompression can also form in or around the inner ear and so disrupt its function – inner ear decompression illness. In addition, a variety of other non-diving-related conditions affecting the ear can cause symptoms in divers during or after a dive.
Signs and symptoms associated with inner ear dysfunction may include hearing loss, vertigo (spinning), dizziness, ringing or other ear sounds (tinnitus), nausea and vomiting.
Any diver with these signs or symptoms after diving should promptly call a DAN-supported diving emergency hotline for advice (1800 088 200 Within Australia / +61 8 8212 9242 Outside Australia). The doctor or medic will take a thorough history including the dive profile, the mode of equalisation and any equalisation issues, and the time of onset and progression of symptoms. A suitable course of action will then be determined.
Got a Medical Question or Concern? Check out DAN Doc on the Diving Safety section of the DAN AP website.
DAN Insider 
I read Brian Wake’s article on ear pain in “Dive New Zealand” mag. In spite of using the Valsalva Manouvre regularly, I still experienced ear pain on every SCUBA descent. In fact I put off learning to SCUBA for over twenty years because it even affected me when snorkeling. I asked for advice on how I might overcome it lots of times, from many dive instructors and operators, and including my PADI instructor. Take it slowly they said – I did and it never helped. I eventually met one dive operator who asked me to show him how I did it, and having verified that my technique was good, he asked the vital question…
“When do you do it?”. I told him I started at the first sign of discomfort.
He suggested that I start doing it ON THE SURFACE, (before any discomfort at all) and then every 0.5 – 1m as I descended to begin with, and hey presto – no pain. That was twenty years ago, and I have never had any trouble with it since – so long as I follow his advice. I also apply it with great effect when coming in to land in aeroplanes, which had been another area of difficulty.
What concerns me is that so many “experts” had for so many years missed this very simple fix. I’d love to think that by passing it on I was helping others to overcome a painful and potentially life-limiting problem.
LikeLike