Bad Ears and Scuba: Technique or a Doctor's Call

The conversation at the counter tends to go well until the ears come up. Someone has asked about the Open Water course. Then the shrug: they'd love to, but they've got bad ears. Often the verdict dates from the deep end of a school pool, or a flight that came down fast, and nobody has questioned it since.

Whether you can scuba dive with ear problems depends on which problem you have. Ears that hurt on planes or in a pool, or that won't seem to pop, usually point to equalising technique, and that can be learnt. A current infection, a perforated eardrum, grommets, ear surgery, Ménière's disease or significant hearing loss needs a doctor's sign-off first.

Can you scuba dive with ear problems?

In many cases, yes, because "ear problems" covers two different groups. One is skill and timing. The other is medical, and the Diving Medical Guidance that doctors use with the dive medical form ranks those conditions. A severe risk is one its authors would generally discourage from diving, a relative risk is judged case by case, and a temporary risk means waiting until it resolves.

Pain lasting hours, fluid from the ear or a change in hearing belongs in the medical group, and DAN treats each as a reason for evaluation. PADI is plain that dive staff aren't physicians: only medical professionals can give medical clearance to dive. The table sorts. It clears nobody.

Why can't you equalise your ears?

Often because nobody has shown you a method, or you start too late. The middle ear is an air space behind the eardrum, linked to the back of the nose by the Eustachian tube. DAN notes that water pressure rises by about 0.1 bar a metre, and unless air comes up the tube, the eardrum bows inward. That's the ache at the deep end of a pool, or on a landing plane. DAN's line is plain: pain means you've descended without adequately equalising.

The UK Diving Medical Committee adds a reassuring point: if you hear normally on the surface, your Eustachian tubes are working. Its advice is to practise inflating your ears several times a day for three to four days before diving, though not with a cold. DAN lists seven methods, including these four:

• Valsalva. Pinch your nose and blow gently against it.
• Toynbee. Pinch your nose and swallow. DAN rates it for the way up.
• Frenzel. Pinch your nose, tighten the throat and make a "k" sound.
• Swallowing and jaw movement. Swallowing, yawning or a jaw wiggle opens the tubes briefly, no pinching. DAN says up to 30% of divers can master it.

Timing does the rest. DAN's routine is a gentle equalise on the surface, a feet-first descent, then another every few feet through roughly the first 3 to 4.5 metres. If an ear won't clear, stop, rise until the discomfort goes and try again. Pain is the margin running out, and pushing deeper against it turns a squeeze into an injury. Our guide to equalising your ears has the full routine.

What does the dive medical form ask about ears and sinuses?

One gateway question and a box. Question 4 of the Diver Medical Participant Questionnaire, version 2026-01-01, asks about problems with your eyes, ears, nasal passages, sinuses or teeth. A yes leads to Box C. Its lines cover ear disease or ear surgery, hearing loss or balance problems, sinus surgery in the last six months and recurrent sinusitis in the past 12 months. A yes there means a physician's evaluation before any diving, the pool included. For concerns the form doesn't cover, it says to consult your physician. Our guide to the dive medical form explains the rest.

Sinuses equalise like ears, and the guidance lists recurrent sinusitis as a relative risk. A cold is a temporary reason to wait, covered in diving with a cold or blocked sinuses.

Can you scuba dive with an ear infection, a perforated eardrum or grommets?

Not while an infection is active or the eardrum has an opening. DAN says divers with an ear infection or ear injury shouldn't dive until fully healed and cleared by a physician, and swimmer's ear follows the same rule. If an ear plays up after a dive instead, read blocked ears after a dive.

An open perforation lets water into the middle ear, which DAN warns can bring on sudden vertigo, and the guidance ranks it a severe risk. DAN says most perforations heal within a few weeks. Diving can resume within several months, once a doctor judges the healing adequate and finds no Eustachian tube problem. One that won't heal rules diving out. A healed perforation is a relative risk: a doctor's judgement, not an automatic no.

Grommets keep a small opening in the eardrum on purpose. The guidance lists them as a severe risk, and DAN advises against diving while they're in, because water can reach the middle ear. Once they're out, DAN and DAN Europe ask for at least six weeks of healing, then a doctor's confirmation that the ear works normally. Childhood grommets are unlikely to still be there years later, DAN notes. A small hole occasionally remains, though, and old infections can scar the tubes.

Can you scuba dive after ear surgery such as a stapedectomy?

Possibly, and here the sources disagree. A stapedectomy replaces one of the middle ear's tiny bones with a prosthesis to treat hearing loss. The Diving Medical Guidance lists a history of stapedectomy as a severe risk, alongside ossicular chain and inner ear surgery. DAN Southern Africa says ENT surgeons trained in dive medicine differ, and that small studies found no higher injury rate in divers who could equalise safely. The stakes are higher, though: a dislodged prosthesis can mean surgery and permanent hearing loss.

A June 2026 scoping review in Diving and Hyperbaric Medicine found the evidence limited, and said it doesn't consistently support blanket bans. Its sources commonly advised waiting about three months after middle ear surgery, with healing confirmed. The call belongs to your surgeon and a doctor who knows diving. In South Africa, SAUHMA publishes a listing of dive medical examiners.

Can you scuba dive with tinnitus, hearing loss or Ménière's disease?

It depends on the cause, and Ménière's gets the firmest answer. Its recurring vertigo, hearing loss, tinnitus and ear pressure make it a severe risk in the guidance. DAN warns that vertigo underwater can lead to panic, choking and drowning, and treats persistent or recurrent vertigo as disqualifying, even when medication controls it.

Tinnitus alone is treated more gently. Where it isn't diving-related and its cause doesn't rule diving out, DAN sees no reason to stop diving because of the tinnitus itself. Ringing that starts during or after a dive needs a doctor.

Hearing loss turns on which ear. DAN says most physicians advise against diving with permanent loss in one ear, to protect the other. Loss in both ears doesn't necessarily rule diving out.

Can a Discover Scuba session show whether your ears will cope?

It can answer the technique question, and only that one. With a clean medical form and a worry about clearing your ears, Discover Scuba Diving is a low-commitment way to find out. At Scuba Evolution it's R1,000 for one session in a heated indoor pool in Fourways, equipment included, with a PADI instructor beside you. PADI caps the pool session at 6 metres and says you won't go deeper than you're comfortable with.

It isn't a medical test, and it doesn't replace a doctor where the form asks for one: PADI's FAQ says the same questionnaire comes first. More on the session is in scuba without certification. Start the Open Water Diver course (R5,650) within 12 months and the session can count as its first confined water dive. Open Water is still booked as its own course, at its normal price.

Sources

• Diver Medical Screen Committee, Diver Medical Participant Questionnaire (version 2026-01-01), hosted by UHMS. Question 4, Box C and the evaluation rule. Also the Diving Medical Guidance to the Physician (version 2023-05-31): the risk definitions and the ear, nose and throat risk lists.
• DAN, The Ears & Diving. Equalisation, swimmer's ear, ventilation tubes, tinnitus, hearing loss, vertigo, Ménière's disease and deviated septum. Also DAN's Tympanic Membrane Rupture (Perforated Eardrum).
• DAN Europe, Alert Diver: Ears problems and diving. Grommets, and at least six weeks of healing after removal.
• DAN Southern Africa, Stapedectomy FAQ. Expert disagreement, the small studies and a dislodged prosthesis.
• Riestra-Ayora J et al. Evidence-informed decision aid for fitness-to-dive assessment after otologic surgery. Diving and Hyperbaric Medicine, 2026;56(2):177-184.
• UK Diving Medical Committee, Diver Ear Clearing. Normal hearing and working tubes, and practice before diving.
• PADI, Discover Scuba Diving. The 6 metre pool limit and medical clearance. Also PADI's Discover Scuba Diving FAQs on the questionnaire and Open Water credit.
• SAUHMA, Dive Medical Examiner Listing.

Frequently Asked Questions

Can you scuba dive with an ear infection?
No. DAN says divers with an ear infection shouldn't dive until fully healed and cleared by a physician. The same goes for swimmer's ear.

Can you scuba dive after a perforated eardrum?
Often, once it has healed. DAN says most perforations heal within a few weeks, and diving can resume within several months if a doctor finds the healing adequate.

Can you scuba dive with grommets?
Not while they're in, because water can reach the middle ear. DAN asks for at least six weeks of healing after they come out, then a doctor's check that the ear works normally.

Can scuba diving make tinnitus worse?
An ear injury can bring it on. Forcing an ear that won't equalise can damage the inner ear, and DAN links ringing that starts during or after a dive to barotrauma or decompression sickness. Existing tinnitus isn't a reason to stop if its cause doesn't rule diving out.

Can you scuba dive with hearing loss?
DAN says most physicians advise against diving with permanent hearing loss in one ear, to protect the other. Loss in both ears doesn't necessarily rule diving out, and the guidance excludes age-related hearing loss from its severe list.

Why won't one ear equalise?
Often timing: equalise it earlier and more often. DAN notes a deviated septum can make equalising harder, and suggests an ENT consultation if the difficulty persists. Stop and rise a little when it hurts.

General information only, not a substitute for a dive medical or a doctor trained in dive medicine. In an emergency, call the DAN Southern Africa 24-hour hotline on +27 82 810 6010.

Reviewed October 2026. Devon Ford runs Scuba Evolution, a PADI 5 Star Dive Centre in Glenvista, Johannesburg.