, , , ,

Clearing your Ears In Water and Other Pressurised Environments.

As a diver, clearing your ears may be second nature. However we all had to learn at some stage and damage to your ears from over forceful clearing techniques is possible. So a quick reminder of the many techniques available may be useful.

The theory:

Your ears have an external tunnel that ends with a flexible ear drum. Imagine a real drum that gets compressed if you increase the pressure around it. (See a. in Figure 1.) The frame of the drum is like your skull and the skin of the drum is like your ear drum. Thankfully your ears differ significantly from a real drum! (See Ear anatomy picture below) For example, ach ear has a tube (See b. in Figure 2), which runs from behind the ear drum to the back of your throat. To stop your ear drum being pushed inwards, you need to increase the internal pressure behind your ear drum. You can do this by actively pushing air up these tubes. Unfortunately these tubes can work like flutter valves, hence can get stuck closed if you try too hard or allow the pressure to get too great before clearing your ears. Blockage can also occur when you have a cold and diving may not be possible. So you must not dive if you can’t clear your ears.

The external water pressure on the drum (Figure 1) and internal pressure generated by you (Figure 2):

 

The Techniques:

Try any of the techniques below early and often but perhaps start with 1. and  2. Everyone does it differently and works out which method works best for them. You will know when you have been successful when your ears “pop” and your hearing and perhaps balance returns to normal. Some of these are easier, in a recompression chamber rather than when diving.

1.         Swallowing, which is known as the Toynbee manoeuvre, drinking, sucking sweets, yawning, coughing, blowing your nose are all things we are used to doing and can be useful.

2.         Pinch your nose, close your mouth and try to blow out of your ears gently. Too hard will not work and can do damage. Watch other divers if you need to know how hard to try. This is known as the valsalva manoeuvre.

3.         The Lowry technique involves using all the above.

4.         Edmonds technique involves rocking the lower jaw from left to right and up and down and forwards and backwards, so that the lower teeth project in front of the upper teeth.

5.         Edmonds 2 advice: “Block your nose, close your mouth, then suck in your cheeks then puff them out quickly.”

6.         Try an otovent. (In chamber only) Occlude one nostril and blow up the balloon with the other nostril.  [youtube]http://www.youtube.com/watch?v=yr5wdwn_Xmk[/youtube]

7.         A difficult one to describe is the Frenzel manoevre. This involves closing the mouth and nose and push the back of your tongue up to the roof of your mouth as you swallow.

8.         Some people get good at clearing their ears and can do it without seeming to do anything. This is an advanced technique not discussed here, but everyone started off by holding their nose and blowing gently out of their ears!

Blocked or painful ears are very common while the pressure is increasing and difficulty clearing your ears is nothing to be ashamed of, but pain is a sign of possible barotrauma and definitely to be avoided. Some people simply find it difficult, but the longer and deeper you leave it, the less likely you will be able to clear your ears.

Ear Anatomy

 

(Kindly reproduced from Wikipedia)

Question 1: Who was Valsalva?

He was a 17th Century Italian anatomist, who described this method for expelling pus from the middle ear through a perforated ear drum.

Question 2:

Can I cause a perforated ear drum by clearing my ears too hard?

Yes, but this thankfully only happens rarely and is probably most commonly associated with a pre-existing weakness in the ear drum. Round window rupture and disruption of the middle ear bones are also possible and barotrauma is possible from as little as 2m. Grommets are artificial tubes placed in the ear drum to allow passive ear clearing, but completely preclude diving. Perforated ear drums seem to me to be most commonly caused by jumping into water ‘ear first’

Question 3:

Can I use decongestants to help clear my ears?

Definitely avoid these and do not dive if you cannot clear your ears. If the medications wear off, the ‘reverse block’ may cause barotrauma, intense dizziness and prevent ascent due to pain.

Question 4:

How can I be sure that I am clearing my ears properly?

Practise gently in water and follow the advice from your instructor. If clearing your ears is still causing pain, avoid diving with an upper respiratory infection. Try descending feet first to reduce venous congestion and using the anchor chain to fine tune to the speed of descent. Small ascents may relieve a blockage due to the flutter valve effect. Finally, there may be a correctable cause and a visit to your doctor may be useful.

Question 5:

How can I tell the difference between inner ear DCI and inner ear barotrauma?

This is an important question as the treatments are entirely different. Inner ear DCI requires recompression, but this will worsen inner ear barotrauma. However both may present with dizziness, nystagmus, (eye flicking) nausea, vomiting and unsteadiness. Both are serious conditions and require assessment by a doctor experienced in diving medicine. Inner ear barotrauma is more likely when symptoms begin on compression, with a shallow dive profile and forceful ear clearing. There may be associated ear barotrauma signs and symptoms, such as pain, fullness, unable to clear your ears and red/damaged ear drum.

Whereas the symptoms of inner ear DCI may start after the beginning of the ascent from longer, deeper, mixed gas dives and there may be signs and symptoms of neurological DCI, such as numbness and weakness in the limbs