Ear pain is the most common complaint from scuba divers and is experienced by almost every diver at some point. Some divers call it "ear squeeze." As a diver goes deeper under water and the outer environment pressure increases, the pressure in the middle ear (the part behind the ear drum) is "squeezed" by the increasing pressure of the water from outside.
The middle ear is an air-filled space formed by bone and the tympanic membrane or eardrum. It is connected to the back of the nose by a tunnel called the eustachian tube. Outside air passing through the eustachian tube keeps the pressure in the middle ear equal to that of the outside world. If the eustachian tube malfunctions and a pressure difference occurs across the eardrum, pain or ear squeeze occurs.
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Ear pain occurs during the descent portion of a dive-as the diver drops deeper underwater. The squeezing ear pain most often occurs near the surface where the relative pressure changes are greatest. Each foot below the surface places continuing pressure on the diver. For every 33 feet under water, atmospheric pressure increases in the amount of 1 atmosphere (this can be compared to the pressure of 1 atmosphere for anyone at sea level).
Normally, the eustachian tube will open and allow the pressure behind the eardrum to equalize with the outside pressure of the seawater in the ear canal. But, if the eustachian tube can't do its job, then as the seawater pressure in the ear canal increases, the eardrum is pushed inward, stretching and inflaming the eardrum and causing pain. If the pain is ignored and the diver drops deeper, the pressure will continue to increase and the eardrum may burst, allowing cold seawater to rush into the middle ear. Nausea, vomiting, dizziness, and confusion may follow.
Rapid ascents or descents in a car or commercial air flight may also cause pressure equalization problems in the ear but not to the same degree as in a dive. You may get an ear pop but not an ear squeeze.
There are many reasons for the eustachian tubes not to equalize the pressure:
Upper respiratory infections
Previous facial trauma
Overaggressive ear clearing
Diving Ear Pain Symptoms
Pressure against the eardrum is responsible for the symptoms of ear squeeze. At low pressure, the diver has a feeling of fullness. As the pressure increases, the eardrum bulges inward, swells, and becomes painful.
Continued high pressure can rupture the eardrum. If this occurs, air bubbles may be felt coming from the ear and the pain may lessen. Cold water then enters the middle ear through the hole in the eardrum, and the diver may become nauseated or vomit. The diver may also become disoriented or have a feeling of spinning, referred to as vertigo.
Upon returning to the surface, if the ear drum has ruptured, the diver may feel fluid draining out of the ear or notice hearing loss. Rarely, a one-sided facial paralysis resulting from too much pressure on a nerve in the inner ear may be associated with ear squeeze.