Ask DAN: What Should I Do if I Have Difficulty Equalizing?

I have always had trouble equalizing during descent. I’m not sure whether my technique is incorrect or there is some other issue. I love diving, but I am worried about injury. What should I do to make sure I can dive safely?

If you have trouble clearing, you’re not alone — 25 percent of calls to DAN pertain to ears and equalization. There is a number of potential issues that could be causing you difficulty. These include not only improper technique, but also allergies, illnesses and injuries.

Equalizing Techniques
As divers descend in the water column, the air in the middle ears is reduced in volume by the increasing ambient pressure. To keep the volume of gas in the middle ear constant, divers must equalize. Every diver has difficulty from time to time, but others, like you, always have difficulty. All methods for equalizing your ears are simply ways to open the lower ends of your Eustachian tubes so air can enter. Try one or more of these techniques to see if any of them work for you.

• Passive: Occurs during ascent without effort.

• Voluntary tubal opening: Try yawning or wiggling your jaw. Up to 30 percent of divers can successfully master this technique.

• Valsalva maneuver: Pinch your nostrils and gently blow through your nose.

• Toynbee maneuver: Pinch your nostrils and swallow (this is a good technique for ascent equalization).

• Frenzel maneuver: Pinch your nostrils while contracting your throat muscles and make the sound of the letter K.

• Lowry technique: Pinch your nostrils and gently try to blow air out of your nose while swallowing (think Valsalva maneuver meets the Toynbee maneuver).

• Edmonds technique: Push your jaw forward and employ the Valsalva maneuver or the Frenzel maneuver.

Medical Evaluation
If after practicing the above techniques you still consistently experience difficulty equalizing, it is time to seek medical evaluation. Difficulty equalizing can be symptomatic of larger issues, such as upper respiratory tract infections, hay fever, allergies, drug use, cigarette smoking or a deviated nasal septum. Your physician can help determine whether there is an injury or condition causing the problem and what course of treatment to adopt, if any. DAN medics often get asked if decongestant use is appropriate for divers. Decongestants relieve congestion temporarily but can mask ongoing problems. In addition, using decongestants for four or five days might result in what’s called rebound congestion, making it more difficult to equalize. But if your physician OKs it, decongestants might help.

If you’ve pushed your limits, be alert for ear barotrauma symptoms. Fullness in the ear, ear pain and tinnitus (noise in the ear) after diving are not normal, and if you experience these symptoms, you should consult a physician. Persistent vertigo after a dive is an emergency; get evaluated as soon as possible. Barotrauma damage and inner-ear DCS damage have similar symptoms, but the treatments are vastly different. Recompression helps in cases of DCS, but it can worsen barotrauma.

Get more scuba diving health tips by visiting the Dive Health, Medicine & Safety section of our website.

For more information, visit dan.org/Health.