Equalising Your Ears When Scuba Diving: Techniques and Warning Signs

Ear problems are the most common injury in scuba diving, and nearly half of all calls to the Divers Alert Network (DAN) emergency hotline relate to them. The good news: almost every case is preventable with the right technique, applied early and often, rather than reactively once pain sets in.

Here's what's actually happening in your ears when you descend, the equalisation techniques worth knowing, and when a niggle stops being normal and starts being a reason to end the dive.

Why Your Ears Need Equalising at All

Your middle ear is a small, air-filled pocket sealed off from the outside world, connected only by the Eustachian tube running to the back of your throat. On the surface, the air pressure inside that pocket matches the pressure outside it. The moment you start descending, that balance breaks.

Water pressure increases fast, even in the first few metres, and without equalising, that pressure pushes inward on the eardrum. Left unaddressed, it doesn't just cause discomfort. It causes middle ear barotrauma, more commonly called an ear squeeze: injury to the eardrum and surrounding tissue from a pressure gradient the body couldn't correct in time. It can happen in water as shallow as one to three metres, which surprises a lot of new divers who assume the risk only shows up at depth.

Equalisation Techniques Worth Knowing

Most divers are taught one method first and never learn the others, which is a problem if that one method stops working on a given day. There are several recognised techniques:

• Valsalva manoeuvre: Pinch your nose and gently blow, building pressure in the throat that forces air up the Eustachian tubes. It's the most commonly taught method, but blowing too hard can injure the inner ear, so gentle is the operative word.
• Frenzel manoeuvre: Pinch your nose, close your throat, and use tongue and throat muscles to push air upward. Many experienced divers prefer it because it doesn't rely on lung pressure and is gentler on the inner ear.
• Toynbee manoeuvre: Pinch your nose and swallow. Useful as a backup when Valsalva isn't clearing.
• Swallowing or yawning: Simple, and sometimes enough on its own during a slow descent.

If one technique isn't working on a given dive, switching to another is a legitimate next step, not a sign you're doing something wrong.

The Habit That Prevents Most Problems

The single biggest mistake divers make is waiting until they feel pressure before equalising. By the time you feel discomfort, the Eustachian tube's soft tissue may already be pressed shut by the pressure differential, which makes clearing harder, not easier. Forcing air against a closed tube doesn't open it. It just adds pressure to a system that's already struggling.

The fix is procedural, not technical: equalise before you start descending, then every meter or two on the way down, ahead of any discomfort. Descend feet-first where possible, since it tends to be easier to clear in that position than head-first. If it's not clearing smoothly, ascend a metre or two, let the pressure ease, and try again gently. Forcing it only raises the chance of injury.

When to Call the Dive

If your ears won't clear after a couple of careful attempts, the correct response is to stop the descent and signal your buddy. Continuing without equalisation is how ear squeezes happen. One aborted dive is a minor inconvenience. A ruptured eardrum is a proper injury, and one that can end a dive trip early.

Certain symptoms move beyond "try again next time" and into medical attention territory:

• Sharp pain followed by a sudden release of pressure, which can indicate a ruptured eardrum
• Vertigo or dizziness underwater, which may signal inner-ear barotrauma and is treated as a diving emergency
• Hearing loss, ringing, or a feeling of fullness that persists after the dive ends

Vertigo underwater in particular warrants stopping, holding onto something stable, focusing on your gauges, and signalling your buddy immediately rather than continuing to descend or ascend on your own judgement.

Before You Even Get in the Water

Colds, sinus congestion, and allergies make equalisation significantly harder and raise the risk of barotrauma, since swollen tissue narrows the Eustachian tube before you've even descended. If you're congested, the safer call is usually to skip the dive rather than push through it. Decongestants can help in some cases, but they carry their own risk profile for diving (including the possibility of a "reverse block" as they wear off mid-dive), so this is worth discussing with a doctor familiar with dive medicine rather than self-managing on the day.

Frequently Asked Questions

Why do my ears hurt even in shallow water?
Middle ear barotrauma can occur in as little as one to three metres of water. Depth isn't the deciding factor, pressure change is, and the biggest pressure change per metre happens near the surface.

Is it normal for equalising to get harder as I go deeper?
It shouldn't get progressively harder if you're equalising early and often. If it does, that's usually a sign to slow the descent, try a different technique, or stop and let pressure ease before continuing.

Can I dive with a cold or blocked nose?
It's not recommended. Congestion narrows the Eustachian tube, making equalisation harder and increasing the risk of barotrauma, including on ascent as trapped air tries to expand.

What's the difference between Valsalva and Frenzel?
Valsalva uses lung pressure (pinch and blow) and is the most commonly taught method. Frenzel uses tongue and throat muscles instead of lung pressure, and many experienced divers find it more controllable and gentler on the inner ear.

What should I do if I can't equalise at all?
Stop descending, signal your buddy, and ascend slightly until the discomfort eases. If it still won't clear after a gentle second attempt, ending the dive is the right call, not a failure.

This article is general information, not a medical opinion on any individual's fitness to dive or diagnosis of an ear injury. Persistent pain, hearing changes, or vertigo after diving should be assessed by a doctor familiar with dive medicine, or by contacting DAN Southern Africa directly.