Why Do Your Ears Hurt When Scuba Diving? How to Equalize

Ear pain during a scuba descent often means that pressure in your middle ear has not equalized with the surrounding water. Stop descending: going deeper or blowing harder can cause injury. If gentle equalization does not work, end the dive safely with your buddy or instructor. Source: DAN, Middle-Ear Equalization.

Equalization is a skill to learn before you need it underwater. You should never have to tolerate pain to keep up with a group.

Why does pressure affect your ears?

Your middle ear contains air. The Eustachian tubes connect that space to the back of your throat, allowing pressure to balance. During descent, rising water pressure pushes against the eardrum unless air can enter the middle ear. Congestion, inflammation or a fast descent can make equalization difficult. Continuing may cause middle-ear barotrauma—a pressure injury. Source: DAN, Ear Injuries.

Shallow water deserves attention too. The largest proportional pressure changes happen near the surface, so do not wait until you are deep to start equalizing. Source: DAN, Six Methods to Equalize Your Ears.

How to equalize your ears when scuba diving

Practise gently with a qualified instructor before your dive. Different techniques suit different divers; force is never the solution.

1. Start early. Check that you can equalize comfortably before descending, then repeat frequently before pressure builds.
2. Descend slowly. A descent line can help you control your position and stop promptly.
3. Use a gentle technique. Try a method you have practised with your instructor, such as those below. Never strain or blow forcefully against resistance.
4. Check both ears. If one does not clear, stop your descent and signal your buddy. Rise slightly under control if necessary to ease the pressure, then try gently again.
5. End the dive if you cannot equalize. Do not continue downward hoping the problem will disappear.

Sources: DAN, Middle-Ear Equalization and Ten Tips for Easy Equalizing.

Three gentle ways to help equalize your ears

These are three options to practise with your instructor, not an exhaustive list of equalization techniques:

1. Pinch your nose and swallow (Toynbee). Close your nostrils gently and swallow, without blowing.
2. Swallow without pinching your nose. Swallowing activates muscles that can help open the Eustachian tubes.
3. Move your jaw. Gently move it forward or from side to side, as if starting a yawn, to help the tubes open.

A technique may not work for everyone or at every stage of a dive. Only continue descending when both ears equalize comfortably. Source: DAN, Understand the Ears for Optimal Health.

Never force equalization

Forceful attempts can damage the inner ear. Stop descending if equalization is difficult; do not push through pain. Source: DAN, Ear Injuries.

What is a reverse block?

A reverse block happens on ascent when expanding air cannot escape from the middle ear through the Eustachian tube. The trapped air creates excess pressure, which may cause pain or dizziness. Congestion or swelling can obstruct that escape route; a decongestant wearing off underwater is another possible factor. Forcing equalization is an injury risk, but is not the definition or sole cause of a reverse block. Source: DAN, Middle-Ear Equalization.

Signal your buddy or instructor and control your ascent. Do not forcefully blow more air into your ears. A small, controlled descent may ease the imbalance if conditions and your gas supply allow; gently swallowing or moving your jaw may help air escape. Resume a slow ascent when possible. Never stay underwater beyond safe gas limits trying to clear your ears. Persistent symptoms need medical evaluation. Source: DAN, Alternobaric Vertigo.

Blocked ears or pain after diving: when to get help

Stop further diving if you suspect an ear injury. Seek medical assessment for pain or fullness that persists for more than a few hours, or any blood or fluid from the ear. Sudden hearing loss, vertigo or severe dizziness needs urgent assessment; severe vertigo with nausea requires emergency care. Do not put drops into an ear if a ruptured eardrum is possible. Return after an injury only when a physician confirms it is safe. Source: DAN, Ear Injuries.

Common questions about diving and ear equalization

Can I dive with a cold or blocked nose?

Do not dive when congestion prevents comfortable equalization. Do not rely on decongestants to make an otherwise unsuitable dive possible: effects can wear off underwater, and medicines can have side effects. Discuss medication with a doctor familiar with diving. Source: DAN, Middle-Ear Equalization.

What if only one ear will equalize?

Stop descending; both ears need to equalize comfortably. If the problem keeps recurring, get medical advice before further diving. Trying harder is not a substitute for finding the cause. Source: DAN, Ten Tips for Easy Equalizing.

Does a sudden end to the pain mean I can keep diving?

No. A ruptured eardrum can sometimes relieve pressure and pain. End the dive safely and seek assessment, especially if you notice hearing changes, dizziness or discharge. Source: DAN, Ear Injuries.

Give yourself time to learn

Tell your instructor about previous equalization difficulties before entering the water. Agree how you will signal a problem and stop the descent. There is no benefit in rushing a skill that determines whether the rest of the dive is comfortable.

Planning your first course? Our guide to choosing a dive center can help you prepare questions about instruction and support. You can compare courses on Be Underwater.

This is general educational information, not a diagnosis or a substitute for scuba instruction or medical assessment.