Whether in the laid-back Florida Keys, the pristine beaches of Hawaii, or the chilly kelp forests of Northern California, scuba diving is a favorite summertime activity. Between the sun, salt water, and changes in pressure, though, scuba can spell bad news for your ears, nose, and throat.

Scuba 101 will tell you to equalize your ears early and often, and it’s  true. While it’s important to equalize your ears throughout the dive, the shallowest 10 feet are crucial. Ear problems occur when the pressure outside the ear, caused by descending and ascending in the water, changes, while the pressure inside the ear stays the same. Equalizing your ears allows your eustachian tubes to make the pressure inside your ears the same as the pressure outside.

Pressure increases by 1 atmosphere (14.7 pounds per square inch) for every 33 feet a diver descends in saltwater. If the ears aren’t properly equalized, that pressure can cause the ear drum to stretch, become inflamed, and even rupture, causing permanent damage. In addition to intense pain, a ruptured ear drum may cause nausea, dizziness, and vomiting as seawater rushes into the middle ear.

For some people, just yawning will be enough to “pop” or equalize the ears. Divers can also equalize by squeezing the nose to block the air passage and gently blowing air into the eustachian tubes. Moving your tongue to the roof of your mouth and humming may also help.

If you experience ear pain while diving and are unable to equalize your ears at the depth you are at, you should ascend until you can equalize. If you are unable to equalize at all, the dive may need to be aborted altogether. If you suspect your ear drum has ruptured, you should seek medical care immediately. The Divers Alert Network (DAN) can refer you to the closest medical facility with diving medical specialists.

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