Dr. Grossan's Ear, Nose and Throat Consultant Pages

SCUBA Diving Health Problems

You might also want to try our blocked ears on descent?
Are your ankles sore after diving?
Do you get nosebleeds while diving?
Do you run out of air early while diving?
Is Seasickness a problem in diving?
Ear Pain While Diving .
Perilymph Fistula or Round Window Blowout .


One of the best things any diver can do for his health is to join Divers Alert Network. This is an organization devoted to diver safety and development of good diver education and guidelines. To join call 800 446 2671.

Ankle Pain While Diving

Do you get ankle pain while diving?

It takes a while to get used to the fins no matter how good they are or how much they cost. Before a dive trip, practice with your fins in the pool. A good conditioner for the dive season it to swim with fins and snorkel and enough weight to make you struggle to stay up. A foot exercise is to stand with both feet on the stairs - without the fins- then move back so only the front half of your feet are on the step. Then practice raising your body up by your feet. Do until it hurts, then try to increase your duration.

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Nosebleeds While Diving

Do you get nosebleeds while scuba diving?

Nosebleeds during diving are of no importance. If they don't stop, use any nose drops such as Neosynephrine 1/2 %, put it on cotton, and place the cotton in the nose where it is bleeding and press gently. This usually stops the bleeding. Should the bleeding continue on a daily basis, get Neosporin Ointment, the 15 gms tube. This has a pointed tip that you can insert into the soft part of the nose, squeeze some ointment in, pull the edge of the outer nostril down to seal the nose and gently milk the ointment into the nasal cavity.

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Do you get seasick on the boat or in the water?

Seasickness is a particular problem for divers. They are not permitted to take over the counter anti-seasickness medications. This is because these all have a side effect of drowsiness, which can add to nitrogen narcosis at depth. For every 33 feet you descend it is like having a Martini. Thus if you add the sedative effect of Antivert or Dramamine you may have a problem.

You can take Emmetrol, however. This is an over the counter antinausea liquid, essentially a sugar solution. Often this takes care of the nausea and dizziness. Take a teaspoon on arriving at the boat and keep sipping it as needed. Another trick is to fool your body into thinking you are in an automobile. You have learned to accommodate to the car stop and go and no longer get car sick. Turn your head so that the motion of the boat is like the direction of the car. Click here to go back to the top of this document.

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Trouble Clearing Your Ears

A common problem is difficulty with the ears during descent. When this occurs at 5 feet depth there may be a closure or obstruction of the Eustachian tube. At 15 feet, in a person otherwise healthy, I usually find slow mucociliary flow and correction of this problem allows the diver to continue diving.

Eustacian tube function (ETF) has been shown to be directly dependent upon mucociliary clearance (MCC), the function of this cilia. Serous otitis is significantly present with decreased MCC. In hyperbaric chamber treatment, where hyperbaric oxygen is a known inhibitor of MCC, the incidence of serous otitis is so high that placement of middle ear drain tubes is often necessary. In scuba diving, if the instructor remains in the water in the back of the boat while the motor is idling, he will have difficulty making his next dive because the fuel exhaust that he inhales will impair his ciliary function.

For divers who cannot clear at 15 feet, try lots of hot tea, proteolytic enzyme tablets, one every four hours, dissolve in mouth between the cheek and the gums. Start proteolytic enzyme tablets the day before diving. Don't smoke and avoid boat exhaust fumes. If still not clear, use the pulsating nasal irrigation device daily; start 5 days before diving, and use the morning of the dive. More men than women have this difficulty because more men have a deviated septum or they blow their nose too hard. Blow gently. For regular nasal congestion I usually recommend Zephrex LA taken twice a day. Some of my divers take this reqularly when diving.

For most divers it is best to start proteolytic enzyme tablets the day before diving. For someone who has a history of difficulty in clearing the ears, start 3 days before the dive. proteolytic enzyme tablets can be found on the web and in some stores, but be sure to check that the enzymes are calibrated in enzyme activity units - otherwise they may do no good.

On descent, try to go down on a line feet first, never head down.. Try to clear about every 5 feet. Be gentle.. If trouble clearing, hold the nose and force air very gently. Or go up a few feet. Another technique is to lift the tongue against the roof of the mouth and swallow. All beginning divers have some difficulty in equalizing, so don't be embarrassed. .

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Ear Pain While Diving

Ear pain while diving can come from several sources:

  • Ear Drum Pain (Myringits)
    If you hit the water with your head to the side, you can slap your ear drum and this can be painful. This is called a myringitis or pain of the ear drum . After diving, this is a common cause of ear pain, the eardrum has been shoved around so much with clearing too hard, or striking the water too hard, or just a lot of up and down action. Sometimes plain olive oil or baby oil will relieve it. Any soothing ear drop such as auralgan is good. Prevention consists of wearing a hood while making a leap from the boat and clearing the ears GENTLY.

  • Outer Ear Infection (External Otitis)
    Ear pain, especially after several dives, is most commonly caused by an irritation of the ear canal. The problem here is that once the canal starts to swell, it is surrounded by bone and this acts like a pliers squeezing on the sore ear canal. Generally pain here is 3x greater that the same swelling on your hand or cheek. If the canal swells completely shut it is VERY painful. Fortunately the severity of the pain doesn't mean it is more serious, just that the swelling is in a tender sensitive area.

    You can prevent outer ear pain by NEVER washing your ears with soap and water. You need the wax in your ear to protect you from the ravages of swimming and diving. Alcohol and peroxide both take away natural wax and make one prone to outer ear infections. I advise my divers to always put baby oil or olive oil in the ear canal before washing the hair and any activity where soap or water can enter the canal. Because of the shape of the ear canal, like a bent baby bottle, once the soap gets in there, you cannot take it out and it just lays there and reduces wax and oil formation.

    Treatment should be started at once. Do not put heat to the ear. The pain is due to the swelling, so heat will cause it to swell more. Take an antihistamine such as chlorpheniramine 4 milligrams (no prescription)4 times a day. Proteolytic enzyme tablets are good for reducing swelling (Papaya Enzyme) The doctor may elect to give an antibiotic. Ear drops such as Cortispoin Otic Solution are good. If the canal is very painful and swollen we generally put a wick or drain in. This allows the drainage to come out and the medicine to go in. It is important to clear this type of condition as quickly as possible because the longer the outer ear infection stays, the more tendency to reoccur. Therefore you should stay out of the water until clear. Once you have had this type of infection I advise my divers to take an antihistamine the moment they feel this coming on. Do not take antihistamine while diving. Any antihistamine can make you drowsy and add to nitrogen narcosis -remember, every 33 feet is equal to one martini.

  • Middle Ear Infection
    Ear pain can come from the middle ear. This may be a regular middle ear infection (otitis media.) Except for when the ear drum is bulging outward severely, this type of infection is not especially painful. In children is painful because pus builds up and bulges the ear drum. It may be caused by blowing the nose too hard and forcing the nasal pus up the eustachian tube into the middle ear cavity where the bacteria multiply. If there is heavy phlegm or pus in the nose, using the pulsating sinus irrigator daily 5 days before diving may prevent eustachian tube blockage.

  • Blockage On Descent.
    Water presses on the ear drum because the ear doesn't equalize. The drum becomes irritated just like having a 15 pound weight on your eyeball would. Once your down, if the ear blocks, the air can expand and if the pressure is not relieved could rupture the ear drum. A ruptured ear drum as a rule is not painful and is not a medical emergency. Just avoid putting drops in the canal which can carry bacteria into the middle ear. 90% of ruptured ear drums heal without problems.

  • Rupture of the Round Window
    A rupture of the round or oval window of the inner ear, also called a perilymph fistula, is never painful. This leaves an opening so that inner ear fluid escapes and can cause permanent hearing loss. This is caused by forcing the blocked ear open with too much pressure. Therefore always be gentle. If you can't clear, go up 5 feet and try again.

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    Perilymph Fistula or Round Window Blowout

    Perilymph fistula (PLF) is one of the serious complications of diving. When the diver blows his nose too hard or forces air into the eustachian tube from his nose as hard as he can in order to clear his ears, the pressure may blow out his ear drum. He will feel cold water enter his ear and probably feel dizzy due to the cold hitting one ear while the other eardrum is intact. This complication is not serious and the ear drum generally heals O.K. without any permanent damage.

    But if the pressure in the middle ear makes a hole in the round window of the inner ear, this is very serious and can cause a permanent damage. There are two openings to the inner ear, both very very tiny. One is connected to the Stapes bone. When the ear drum vibrates, the stapes moves in and out, sending a wave of water in the inner ear. The stapes moves in causing a wave. This same wave travels round and round and pushes the round window out. This is the basis of the hearing mechanism. When a hole in forced into the round window, the fluid of the inner ear can leak out and cause deafness. This hole is called a PLF.

    The PLF is not painful. When the doctor looks in your ear he sees an intact drum. The only signs may be hearing loss, tinnitus and dizzyness. Sometimes only one of these symptoms is present.

    The best treatment in my experience is surgery. We lift up the ear drum and plug the hole. There isn't universal agreement as to the best treatment. Some doctors feel the person can be put to bed, with the bad ear up in order to lower the pressure and help the healing. Others go for medicine such as cortisone.

    What is important is that if PLF is suspected, call DAN for a referral to an Ear Nose and Throat specialist. Do not inflate the ears- this will make the hole bigger.

    Sometimes it is hard to make the diagnosis. If the ear drum is red from diving, the diver will say he can't hear. A special hearing test - an audiogram- done is a sound proof booth is necessary to determine if the hearing loss is due to the ear drum being swollen, the eustachian tube being blocked or fluid behind the ear drum. In my practice, if there is a history of difficulty clearing, even if I see a red drum, fluid behind the ear drum, I still do an audiogram because there could still be a PLF present, behind all these things.

    One test we do is to seal the ear canal, bring up the pressure in the canal and if this makes the patient dizzy, it indicates a hole in the inner ear - PLF.

    Prevention: Do not force hard to clear your ears. Go down feet first. Clear every 5 to 10 feet. If you can't clear, go up 5 feet and try again.

    You can also get a PLF by heavy straining. Head stands - remaining upside down is a cause. Also, straining to put the motor cycle onto the tail gate of a car. Diving for pennies in the pool can do it. Even straining for a bowl movement.

    Once the hole has been sealed, we recommend the diver not dive again because the same conditions that made the hole in the first place, may cause a recurrence. However, several of my patients did return to diving and have been O.K.

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    Murray Grossan M.D.

    Last Update 2003 Nov. 6