Ask DAN: How Can You Prevent Ear Troubles While Diving?

I’ve recently earned a scuba certification and am about to take my first dive vacation, but I’m nervous that ear problems will keep me on the boat. Any tips?

As divers, we know that nothing can end a perfect dive quicker than ear troubles. Whether it’s an ear infection, sinus congestion or something more serious, we need healthy ears to dive safely and without injury. Aural health and hygiene, however, is frequently overlooked when divers prepare for the upcoming dive season or a long dive vacation. Divers will spend days organizing gear, travel plans and course schedules, only to get to the location and realize a problem with their ears is preventing them from diving. Or worse, they take over-the-counter medications to mask the symptoms of their ear troubles. It is true that the anatomy and workings of the ear can be intimidating, but learning how to keep your ears healthy and properly functioning is vital to a lifetime of safe diving.

Aural hygiene
It’s rarely the source of dinner-table conversation, but aural hygiene is crucial to your health and safety in the water, and neglecting the cleanliness of your ears can result in lifelong consequences. An earwax plug that seals the ear canal can cause explosive tympanic membrane perforation during a dive, or cause caloric vertigo by preventing one ear from being naturally chilled by contact with the water. Incomplete blockages of the ear can prevent adequate drainage of the ear and cause infection, or exacerbate the symptoms of a current infection. Infections of the ear canal are often associated with persistent moisture and local skin trauma, which can be caused by inserting cotton swabs or other objects into the ear. Our DAN medics are fond of advising divers not to “put anything smaller than your elbow in your ear.” A healthy ear will have some amount of earwax, but you can prevent excessive buildup by properly cleaning your ears, occasionally washing them with a bulb syringe filled with a mixture of warm soapy water and hydrogen peroxide. On long diving trips when your ears might be exposed to even greater stressors, using a mixture of half white vinegar and half rubbing alcohol will cleanse and dry the ear canal, as well as change the pH balance of the ear canal to reduce the risk of infection. If you have difficulty getting water out of your ears, you can try lifting the ear upward and back to straighten the ear canal, and using a hair dryer to blow warm air into the ear canal for five minutes.

Eardrops
Most divers should not need to use eardrops after diving, but for those prone to getting the external ear-canal infection known as swimmer’s ear, they can be useful. To help avoid swimmer’s ear, gently rinse the ears with fresh water immediately following the dive, and dry them with a hair dryer, or use eardrops that are formulated to help the ear dry after use. Common ingredients in effective eardrops include acetic acid, boric acid, aluminum acetate, sodium acetate, isopropyl alcohol and glycerin. The acids alter pH and slow the growth of bacteria, while the aluminum and sodium acetate are astringents, which serve to shrink tissues and draw excess water out of the lining of the ear canal. Isopropyl alcohol helps to dry the tissues, and glycerin can help to moisturize the skin. For more information on ear health and diving, visit dan.org/health.

When to Take Decongestants

These drugs can help with allergies but also carry the risk of adverse side effects.

A diver considering the use of any medication should first consider the underlying reason for taking that drug. Does the underlying condition affect a diver’s safety in the water or compromise the safety of those around him or her? Before taking decongestants this season, step back and take a moment to consider if a decongestant is an appropriate treatment for your symptoms, or whether you should avoid diving until your symptoms subside.

What are decongestants?
Decongestants are vasoconstricting drugs that cause the narrowing of blood vessels and reduce swelling of nasal mucosa, offering temporary improvement of the nasal airways. They are often combined with antihistamines to help reduce allergy symptoms.

When should I take them?
It is generally acceptable to use decongestants to improve some symptoms of allergies before diving, but a diver should discuss his or her condition or specific concerns with a qualified physician.

What are the side effects?
Decongestants might cause mild central-nervous-system stimulation, as well as side effects like nervousness, excitability, restlessness, dizziness, weakness, and a forceful or rapid heartbeat. Divers should be concerned with an inability to equalize, cardio effects and possible rebound congestion.