Ear problems are among the most common injuries in diving, and they can quickly turn a great trip into a painful and potentially dangerous experience. One diver recently learned this the hard way after struggling to equalise, only to develop muffled hearing, buzzing, and balance issues that continued even after surfacing. A specialist later discovered hardened, darkened mucus behind the eardrum — a tell-tale sign of middle-ear barotrauma. Understanding how this happens, how it’s treated, and what it means for returning to diving is crucial for anyone who spends time underwater.
Q: On a recent dive trip, my husband had problems clearing his ears, and by the second day he complained of muffled hearing, a constant buzzing sound and trouble with his balance. We stopped diving, waited an appropriate surface interval and flew home to see an ear, nose and throat specialist. The doctor found excess mucus behind my husband’s eardrum; it had hardened and turned black. He made an incision, removed the mucus and expressed amazement that my husband had experienced no problem flying. Can you tell me what happened and if my husband can dive again?
A: These symptoms are consistent with middle-ear barotrauma, which is associated with the inability to equalise the middle-ear air space when diving.
This is usually due to variable degrees of Eustachian tube dysfunction and most commonly caused by a problem like a recent cold, allergies or any type of irritation, which inflames the mucous membranes and causes swelling and mucus discharge.
The pain, muffled hearing, buzzing sounds and difficulty with balance can all be caused by pressure and in this case appear to be from a fluid build-up in the middle-ear air space. The constant pressure exerted by the fluid on the inner ear is what produced your husband’s symptoms.
It seems the barotrauma was also sufficient to cause bleeding into the middle ear; this is why the mucus turned black.
Bleeding indicates a fairly serious injury, so your husband was fortunate that he didn’t rupture his eardrum or one of the internal membranes of the ear, which could result in decreased or a permanent loss of hearing.
The small incision in the eardrum, or myringotomy, was necessary to drain the ear of excess mucus and provide an opening to ambient air, which can help dry out the middle ear.
If the ear was full of blood and other tissue fluids during the flight, an increase in symptoms would not have necessarily occurred, since the lower pressure in the aircraft cabin would have been transmitted through the fluid-filled middle-ear chamber.
Only time will tell if your husband can return to diving. Depending on the severity of the injury, your husband should wait at least six months and then return to his physician for a complete examination, including a hearing test (return sooner if there are infections or hearing or balance problems).
If the specialist determines there is no permanent damage to your husband’s Eustachian tubes or structures of the middle ear, chances are he can dive again.
If your husband is cleared to resume diving by his physician, it’s important to take steps to prevent this injury from happening again. The safest approach to preventing middle-ear or sinus barotrauma is to avoid any discomfort in these air spaces.
Equalise before you feel pressure. If you feel pain, damage has already occurred. Be sure to make slow, steady descents, and equalise early and often as you go. If you cannot clear your ears, it’s best to sit out the dive and not risk another injury.
For an extensive range of diving health and safety information and downloadable resources, research studies, incident summaries, and free e-Learning courses, take the time to explore the DAN website.
FAQ: Middle-Ear Barotrauma in Diving
Q: What is middle-ear barotrauma?
A: Middle-ear barotrauma occurs when divers can’t properly equalise pressure in the middle ear, leading to fluid build-up, muffled hearing, pain, and sometimes balance issues.
Q: What are the common causes of middle-ear barotrauma?
A: Causes include congestion from colds or allergies, Eustachian tube dysfunction, or descending too quickly without equalising.
Q: How is middle-ear barotrauma treated?
A: Treatment may involve draining fluid through a small incision in the eardrum (myringotomy), rest, and follow-up care from an ENT specialist.
Q: Can a diver fly with middle-ear barotrauma?
A: It’s risky, as cabin pressure changes can worsen symptoms. However, if the middle ear is filled with fluid, some pressure changes may be buffered. Always seek medical clearance before flying.
Q: Can you dive again after middle-ear barotrauma?
A: With proper healing and no permanent damage, many divers can return to diving after medical clearance. Doctors typically recommend waiting at least six months and undergoing a hearing test.
Q: How can divers prevent middle-ear barotrauma?
A: Equalise early and often, descend slowly, avoid diving with congestion, and never force equalisation. If you can’t clear your ears, it’s safer to skip the dive.
This article was originally published in Scuba Diver Magazine
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