Quick disclaimer (please read) We’re not doctors. We’re divers. This article is based on dive safety guidance and well-known diving medicine resources, plus what we see day-to-day on dive boats. It is not medical advice and it cannot diagnose you. If you have severe pain, hearing loss, vertigo (spinning), ringing that won’t stop, fluid or blood from the ear, fever, or you just feel “not right”—pause diving and get checked by a doctor (ideally an ENT). When in doubt, get help early. Some ear problems are time-sensitive. Why divers get ear problems so often Diving is basically a sport where you change pressure on your body over and over. Your ears are full of small spaces and delicate parts. They usually handle diving just fine—until they don’t. Most ear issues in diving fall into a few buckets: Outer ear problems (ear canal): water, irritation, infection (“swimmer’s ear”), wax, narrow canals. Middle ear barotrauma (behind the eardrum): equalisation problems, “ear squeeze,” congestion, poor technique like descending too quickly. Inner ear problems (deep ear): rarer but more serious—inner ear barotrauma or inner ear decompression sickness. We’ll talk about inner and outer ear issues, but we’ll also touch on middle ear, because most “ear trouble” starts there and it links directly to inner ear risk. Maintenance: daily habits that save your ears This section is the boring one. It’s also the section that prevents the most problems. 1) Rinse with fresh water after every single dive If you’re prone to swimmer’s ear or irritation, gently rinsing your ears with fresh water after diving can help remove salt, sand, and “reef soup” from the canal. Keep it gentle. You’re not pressure-washing your head. Just a rinse to flush out salty water: tip your head to the side, allow the shower water to run into your ear, gently massage next to your ear and top your head the other way to drain them out. Repeat this process 2-3 times. I cannot stress enough, simply doing this every time will prevent most issues you can have with your outer ear. 2) Dry ears carefully (no poking) Moisture sitting in the ear canal is a big reason outer ear infections happen. DAN notes that gently drying the ears can help—some divers use a hair dryer on a low, warm (not hot) setting, held at a safe distance. What not to do: No cotton buds / Q-tips deep in the ear. They push wax in, scratch skin, and can trigger infections. No “digging” with fingernails, keys, hair pins, or the corner of your towel (yes, people do this). 3) Be cautious with “ear magic,” alcohol, or vinegar mixes Some divers swear by drying drops (often containing alcohol and/or acids like acetic acid). DAN mentions that commercial drops may help when simple rinsing and drying isn’t enough, and lists common ingredients found in them. That said, your instinct is a good one: don’t make alcohol drops your default daily habit. Especially the alcohol based ones which can kill all the good bacteria in your ears, leaving you prone to infection. Over-drying and irritation can backfire for some people. Also, never put drops in an ear if you might have a perforated eardrum, ear tubes, severe pain, or infection symptoms—that’s a “doctor first” situation. If you do use preventive drops, treat them like a tool, not a lifestyle. And if you’re unsure, ask an ENT or a dive medicine clinician what’s safe for your ears. 4) Equalise early, often, and gently This is the big one. Most dive ear injuries start with poor equalisation timing or force. Start early: equalise on the surface and in the first meter or two. Equalise often: small pressure changes are easier to equialise than big ones. Stop if it doesn’t work: if you don’t feel equalisation happening, stop descending and try again. Never push through pain: pain means you’re not equalised—ascend slightly until it settles, then try again. DAN specifically warns that forcing air against closed Eustachian tubes can lock them shut and cause barotrauma, and that blowing too hard (especially with Valsalva) can risk inner ear damage. 5) Don’t dive congested (and don’t “medicate your way through”) Colds, allergies, sinus congestion, and swollen Eustachian tubes are a classic setup for ear squeeze and reverse block. DAN lists congestion as a key prevention point for middle-ear barotrauma: don’t dive when congested. If you’re relying on decongestants to “make the dive happen,” be honest with yourself. Meds can wear off mid-dive and create a reverse block on ascent. If you’re unsure, sit it out. Missing one dive is better than missing a month. Think of how many Whalesharks you could miss 6) Go slow, and descend feet-first when possible Many divers equalise better when they descend slowly and stay more upright. If one ear is stubborn, DAN suggests tilting the blocked ear toward the surface and ascending slightly rather than bouncing up and down. 7) Keep your hood and fit in mind Cold water hoods can trap air and create weird pressure sensations. Make sure your hood doesn’t seal over the ear in a way that traps a pocket. DAN’s ear reference also notes wearing a hood in cold water can help overall ear health (especially for infection-prone divers). 8) Look after wax and narrow canals Some people produce more wax. Some have naturally narrow canals. Both can trap water and raise infection risk. DAN suggests regular checks if you tend to build wax blockages. Important: earwax removal should be done safely (ideally by a professional). DIY scraping is a common way divers injure the canal. 9) Watch the air conditioning (it can dry you out and tighten things up) This one surprises a lot of divers, especially people arriving from colder climates or spending hours in strong air con. Dry, chilled air can dry out your nose and throat, irritate the lining of your sinuses, and make the Eustachian tubes a bit cranky. If those tubes are swollen or dry, equalising can feel harder than usual—even if you’re “not sick.” Common setups that cause trouble: Overnight buses/trains with freezing air con blasting your face Airplanes (dry cabin air) plus a cold hotel room straight after Sleeping under the AC vent with your mouth open (we’ve all done it) Simple fixes that help: Don’t sleep with the AC blasting your face. Point the vent away, raise the temperature a bit, or use a light blanket. Hydrate more than you think you need. Dry air plus salty boat days can dehydrate you fast. Use saline spray or rinse (plain saltwater nasal spray) if you tend to dry out—especially after flights. Warm shower steam before diving can help loosen things gently (no aggressive “clearing”). Build in a buffer day after long travel if your ears are sensitive, so you’re not forcing equalisation on Day 1. Most importantly: if equalisation feels “sticky” after a cold, dry travel day, slow your descent and keep it gentle. Don’t force it. If it’s not happening, call the dive early and let your ears settle. Missing one dive beats battling your ears for a week. Inner ear problems (the serious stuff) Inner ear issues are less common than outer ear infections or middle ear squeeze, but they matter because they can involve lasting hearing or balance damage if not treated properly. In diving, two inner ear conditions get a lot of attention: Inner Ear Barotrauma (IEBT) – typically linked to forceful equalisation or pressure transmission through the middle ear. Inner Ear Decompression Sickness (IEDCS) – a form of DCS affecting the inner ear, often tied to deeper/longer dives and decompression stress. They can look similar at first. That’s why a “wait and see” approach is risky. Symptoms that should make you stop diving immediately Vertigo (spinning sensation), especially if it’s sudden or severe Hearing loss (muffled hearing, sudden drop, or “one ear went quiet”) Tinnitus (ringing, roaring) Nystagmus (eyes flicking side-to-side—often someone else notices) Nausea/vomiting with dizziness DAN highlights vertigo, nystagmus, and hearing loss as suggestive signs for IEBT and strongly discourages continued diving until evaluated by a specialist. How inner ear barotrauma happens Inner ear barotrauma is often linked to pressure problems and force. A common scenario looks like this: Diver has trouble equalising (tight tubes, congestion, rushed descent). Diver performs a strong, repeated Valsalva (blowing hard against a pinched nose). Pressure transmits through the middle ear and can injure the delicate inner ear structures (including the round/oval windows). Medical diving references describe inner ear barotrauma mechanisms and warn about possible perilymphatic fistula (a leak of inner ear fluid) with vertigo and sensorineural hearing loss. How inner ear decompression sickness happens Inner ear DCS is different. It is related to inert gas bubbles affecting the inner ear during or after diving, especially with higher decompression stress. It may occur after deeper dives, repetitive dives, rapid ascents, or aggressive profiles. A 2021 review discusses IEBT and IEDCS as the two main dysbaric inner ear injuries in diving. Inner ear diagnosis: what doctors look for Because symptoms overlap, clinicians look at: Dive profile history: depths, times, repetitive dives, ascents, any omitted stops. Event timing: symptoms during descent (more suggestive of barotrauma) vs after ascent (can suggest DCS). Ear exam: signs of middle ear barotrauma (blood behind the eardrum, swelling, fluid). Hearing tests: formal audiometry. Balance tests: vestibular testing. The Merck Manual advises that patients with tinnitus, hearing loss, or vertigo suggesting inner ear barotrauma should be urgently examined, undergo audiometry/vestibular testing, and be referred to ENT because prompt treatment of inner ear window tears can reverse hearing loss in some cases. Inner ear treatment: what typically happens Treatment depends on the diagnosis, and this is where professional care matters. In general: Stop diving immediately. Seek urgent medical evaluation. ENT involvement is common. Avoid straining: DAN suggests conservative measures like rest in a sitting position and avoiding straining that increases pressure (this is aimed at minimizing further inner ear stress while being evaluated). If DCS is suspected: hyperbaric evaluation and recompression treatment may be indicated (this is a medical decision, not a DIY decision). Bottom line: if vertigo or hearing loss appears around a dive, treat it as urgent. Don’t “sleep it off” and do another dive tomorrow. How to reduce inner ear risk Gentle equalisation only. No forced Valsalva. Slow descents. Equalise early and often. Abort early if equalisation fails. Don’t turn it into a wrestling match with your Eustachian tubes. Dive conservative profiles and follow computers/tables properly (especially on repetitive days). Stay hydrated, rested, and calm. Stress and rushing make bad decisions more likely. Outer ear problems (the common stuff) Outer ear problems happen in the ear canal. The classic one for divers is otitis externa (swimmer’s ear). It’s very common in warm water locations and on multi-day dive trips. What causes outer ear infections Swimmer’s ear is usually caused by a mix of moisture, tiny skin damage, and bacteria/fungus that love warm, wet places. Diving adds extra ingredients: salt, sand, sunscreen, sweat, and repeated wet/dry cycles. Common triggers: Water trapped in the canal after diving Scratching or over-cleaning (cotton buds are a top offender) Wax buildup that traps moisture Narrow canals / exostoses (“surfer’s ear”) that reduce drainage DAN’s ear hygiene guidance notes that rinsing with fresh water and gentle drying can help for divers plagued by swimmer’s ear. Outer ear symptoms (what it feels like) Itchy ear canal Pain when touching the outer ear or pushing on the tragus (the little flap) Feeling of fullness or blockage Drainage Swollen canal (sometimes your hearing feels muffled because the canal narrows) Outer ear diagnosis Diagnosis is often straightforward: a clinician looks into the ear canal (otoscope) and sees redness, swelling, debris, and sometimes discharge. If it’s severe or recurrent, they may consider underlying causes like eczema, fungus, chronic wax, or exostoses. Outer ear treatment (general overview) Swimmer’s ear is commonly treated with prescription ear drops (antibiotic and/or steroid drops, sometimes anti-fungal depending on cause). Severe swelling may require a wick to deliver drops deeper into the canal (again, that’s clinician territory). For divers, the key practical points are: Stop diving until it’s improved. Diving on a painful canal is miserable and can worsen it. Don’t put random drops in a painful ear. Especially if there is any chance the eardrum is damaged. Don’t block the ear with plugs unless an ENT has recommended a specific solution for you (plugs can trap moisture and worsen infection). How to prevent outer ear problems This is where your “maintenance” section becomes your superpower: Fresh water rinse after diving days (gentle). Dry carefully (hair dryer low/warm, at distance, not hot). Don’t scratch or clean aggressively. Manage wax (regular checks if you’re prone). Be cautious with drops and only use them appropriately; avoid if perforation/tubes/infection is suspected. A quick note on “ear beer,” alcohol/vinegar, and why divers argue about it Some dive medicine resources describe alcohol/vinegar mixes as a cheap way to dry the ear and alter pH, making bacterial growth harder. But “works for some” is not the same as “good for everyone.” Overuse can irritate sensitive skin. And it can be unsafe if the eardrum is not intact. So our calm, practical take is: Start with the basics: rinse and dry. If you keep getting infections, talk to a clinician about a prevention plan that fits your ears. If you ever suspect a perforation (pain + sudden relief + vertigo/hearing change, or blood/fluid), do not put drops in—get checked. Middle ear problems (quick but important context) You didn’t ask for a full middle-ear chapter, but it connects everything, so here’s the “need to know.” Middle-ear barotrauma (“ear squeeze”) is the most common diving ear injury. It happens when you descend without equalising the middle ear pressure through the Eustachian tubes. DAN lists symptoms like ear discomfort that increases with descent, fluid buildup, and potentially eardrum rupture. Key prevention points (straight from DAN-style advice): don’t dive congested, learn good equalisation technique, and abort the dive if you can’t equalise. Why mention this here? Because forced equalisation and severe middle-ear issues can be a pathway to inner ear damage. Simple “what should I do right now?” guide Scenario A: itchy canal, mild discomfort, worse when you tug the ear Likely outer ear irritation starting. Pause diving if it worsens. Rinse/dry gently. If pain ramps up, get checked for swimmer’s ear. Scenario B: pain on descent, feeling “blocked,” improves when you ascend a little Classic equalisation problem. Stop descending, ascend slightly, try gently. If it won’t equalise, abort early. Don’t force it. Scenario C: sudden vertigo, hearing loss, loud ringing, nausea during/after a dive Stop diving and seek urgent medical evaluation. Inner ear issues need professional assessment quickly. Wrap-up: ears are part of diving life (manage it, don’t wrestle it) Most divers will have an ear issue at some point. It might be mild: itchy canals after a windy boat day. It might be annoying: a blocked ear that makes you miss a dive. And occasionally it can be serious: vertigo or hearing loss that needs urgent care. The goal isn’t to pretend ear problems won’t happen. The goal is to: Reduce your risk with simple maintenance (rinse, dry, don’t poke). Equalise gently and early, and never force it. Recognise red flags and get help fast when symptoms suggest inner ear trouble. If you dive long enough, you’ll have “an ear day.” The win is handling it calmly and not turning a small issue into a big one. Come dive with us (and tell us about your ears)If you’re diving with Phoenix Divers, tell your instructor or guide if you’ve had ear issues in the past. We can help you slow descents, practise gentle equalisation, and choose profiles that feel comfortable. And if something feels off, we’ll always support the smart call: pause, rest, and get checked. Message us if you want help planning a dive schedule that’s kind to your ears.Get in touch