How to Equalize Your Ears When Diving: Techniques, Tips and Problems

Why your ears hurt underwater

Behind your eardrum is the middle ear, a small air space connected to the back of your throat by the Eustachian tube. As you descend, water pressure pushes your eardrum inward, which you feel as pressure, then pain. To balance it, you need to push air up the Eustachian tube into the middle ear. That's equalizing.

The biggest pressure change is near the surface: pressure doubles between 0 and 10 m. That's why the first few metres need the most attention.

The golden rules

1. Equalize early: start at the surface, before you descend, and gently again in the first metre.
2. Equalize often: every metre or so, before you feel pressure.
3. Descend slowly, feet first: ideally along a line or the reef slope, so you can control speed.
4. Never force it: if it won't clear, ascend a metre or two and try again.
5. Never dive with a cold or congestion.

Equalization techniques

Valsalva manoeuvre

Pinch your nose and blow gently against it, as if blowing your nose into a closed tissue. It's the technique most people learn first. Blowing too hard can damage the inner ear, so be gentle and never keep pushing against a block.

Toynbee manoeuvre

Pinch your nose and swallow. Swallowing opens the Eustachian tubes, and the throat movement helps.

Lowry technique

A combination: pinch your nose and gently blow while swallowing. Many divers find it very effective.

Frenzel manoeuvre

Pinch your nose, close the back of your throat (as when lifting something heavy), and push your tongue up and back like saying "K". It pumps a small amount of air with little pressure. It's favoured by freedivers and it's gentler on the ears. It takes practice.

Voluntary tubal opening ("hands-free")

Some people can open their Eustachian tubes by tensing muscles at the back of the throat, like the start of a yawn with the jaw pushed forward. It can be learned with practice.

Helpful movements

Wiggling your jaw, tilting your head to the side (the blocked ear upward), swallowing and gentle yawning motions can all help, combined with the above.

Practise before your trip

Practise on land: pinch your nose and gently equalize. You should feel a soft "pop" or "click" in both ears. If you can't feel it at all, or only on one side, practise daily, and consider seeing an ENT doctor before your course. It's also a good idea to practise on aeroplanes.

Mask and sinus squeeze

• Mask squeeze: air in your mask compresses and pulls on your face. Exhale gently through your nose into the mask as you descend.
• Sinus squeeze: pressure or pain in your forehead or cheeks, usually from congestion. Ascend a little, and if it doesn't clear, end the dive.

Reverse block (on ascent)

Occasionally air can't escape from the middle ear or sinuses as you ascend, causing pressure or pain. It's more common when decongestants wear off during the dive. Stop, descend slightly, and ascend very slowly. Try swallowing and wiggling your jaw. Don't use the Valsalva on ascent.

What about decongestants?

Some divers use decongestant sprays or tablets to help equalization. This is a medical decision: decongestants can wear off mid-dive (causing reverse block), have side effects, and don't fix the underlying problem. Ask a doctor with diving knowledge. Never use them to "push through" a cold.

Signs of ear injury (barotrauma)

• Pain that continues after the dive
• Feeling of fullness or fluid in the ear, muffled hearing
• Blood from the ear or nose
• Ringing (tinnitus), dizziness or vertigo, especially if persistent: this may indicate inner-ear injury and needs urgent medical attention

Stop diving and see a doctor. Continuing to dive with an ear injury can make it much worse.

Ear care between dives

• Rinse ears with fresh water after diving and dry them gently (tilt your head, use a hairdryer on a low setting from a distance)
• Consider drying drops (commonly alcohol/acetic acid solutions) if you're prone to "swimmer's ear". Check with a doctor, and never use them with a perforated eardrum
• Don't use cotton buds deep in your ears

Frequently asked questions

Why can I only equalize one ear?

Eustachian tubes often differ in size or openness. Tilt your head with the blocked ear upward, move your jaw, ascend slightly and try gentle techniques again. If it happens every time, see an ENT doctor.

Can you dive with a cold?

It's not recommended. Congestion makes equalizing difficult and increases the risk of ear and sinus injuries and reverse block.

Is it normal for ears to feel blocked after diving?

Mild fullness that clears within a few hours can happen. Pain, hearing loss, ringing or vertigo that persists needs medical assessment.