Ear Barotrauma – The Most Common Scuba Diving Injury And How To Avoid It


“Never go diving with a cold!” This is one of the most stressed credos in a scuba diving entry-level class. Unfortunately, it is one of the most ignored rules by underwater lovers. Some even try using decongestants just because they can’t say no to water calls.

So are you among the guilty ones? How long till your actions catch up with you?  You may not resist the urge to hit the waters now but you might end up feeling sorry that you did.

While diving is a breathtaking activity, if done with a cold, it doubles your chances of ear barotrauma, a very common injury among scuba divers.

Studies show that 30% of new divers and 10% of the skilled ones have experienced episodes of barotrauma at some point in their diving career. The symptoms can be mild or intensely painful, with some cases even reporting permanent hearing loss.

So, What Is Barotrauma?

Barotrauma is derived from “baro” (pressure) and “trauma” (injury), meaning it is a pressure-related injury. Ear barotrauma, therefore, is a condition that occurs when you are not able to equalize the pressure in your ears properly with the pressure exerted by the surrounding waters during a dive.

How Does It Occur?

The most common causes of this ear injury are unequal equalization of pressure, sinus congestion, skipped equalizations, and forced equalizations.

If the air pressure between your outer ear and middle ear exceeds 2 pounds/sq. inch (psi), your eardrum will be disfigured causing discomfort and pain. In some severe cases where the pressure difference is more than 5 psi, the eardrum is likely to rupture.

On the surface, zipping into a wetsuit and strapping a scuba tank for a dive may seem more fun than paddling, but it comes with its challenges and one of these is barotrauma. When you immerse yourself in the water, more pressure is exerted on you than when on the surface. Pressure increases as you go down, and if you haven’t equalized properly, you will start feeling the symptoms of barotrauma in the first 4-5 feet of the descent.

Types And Symptoms

Ear barotrauma can affect the outer ear, middle ear, or inner ear. Let’s dig a little bit into this:

1. Outer Ear Barotrauma

When you descend, pressure accumulates in your outer ear and creates a vacuum. This vacuum causes the skin and blood vessels of your outer ear to swell, forcing the eardrum to bulge outwards. As pressure increases, the blood vessels continue to distend causing pain and discomfort. You may notice some blood coming out of your ear after the dive.


The damaged skin and ruptured blood vessels will heal by themselves with time. But to avoid future incidents, ditch those tight earplugs and dive hoodies.  Also, clean your outer ears regularly to remove wax and any other dirt that can cause a blockage.

2. Middle Ear Barotrauma

This one occurs when your middle ears are not able to equalize the pressure and is one of the most common ear conditions in scuba diving.

Pressure equalization in your ears is determined by the Eustachian tube, a canal that links your middle ear with the nasal cavities. If this tube got some issues, the volume of your middle ear will decrease and pull your eardrum inward, causing pain.

Now, if you decide to continue with the dive even after feeling this discomfort, your middle ear cavity will continue pulling the eardrum to the inside and sooner or later, your eardrum will burst. Once the eardrum is perforated, the pain will subside. However, water will now start flowing into the middle ear.

After the dive, you will experience a feeling of “fullness” in your ears due to the accumulation of water and blood from the rupture. You may also experience dizziness, muted hearing, popping sounds while chewing, soreness of the ears, and fluid dripping from the Eustachian tube to the throat.


Contact an ENT specialist right away, if you experience any of the mentioned symptoms of barotrauma. The physician will prescribe decongestants to drain the fluids from the Eustachian tubes and the middle ear. If there is any infection suspected, antibiotics will be issued.

3. Inner Ear Barotrauma

The inner ear enables you to hear and maintain balance. It is separated from the middle ear by round and oval windows.

If barotrauma attacks your inner ear, you will have tears in the round and oval window, and experience symptoms similar to those of vertigo. These could be accompanied by dizziness, spinning, tinnitus, hearing loss, nausea, and vomiting.


Any injury related to the inner ear is deemed life-threatening, underwater. As we just mentioned, your inner ear helps you to maintain buoyancy. If barotrauma strikes this section of the ear, you may require immediate medical attention.

Mild cases will sometimes heal with bed rest but severe ones frequently require “the knife”. Depending on the seriousness of the injury, your doctor may rule out going underwater in the future.

How Can You Prevent Barotrauma As A Diver?


No matter how experienced you are, how many qualifications you have, or how many dives you have made in your life, you can’t change nature neither can you change its laws. The pressure exerted underwater can expose any diver to the risk of ear barotrauma, but knowing how to deal with those forces can lower your chances of injury. Here are a few things you can do:

  • Don’t go diving if have a cold or chest congestion. Your Eustachian tubes may be swollen or congested and prevent proper pressure equalization.
  • Learn how to equalize efficiently and never do it forcefully
  • Try equalizing while on the surface before the emersion. This will pre-open your Eustachian tubes and prepare your middle ears for effective equalization. If you are having problems equalizing, tell your buddy so that they can be aware of the situation and be ready to provide a helping hand should things go awry down there.
  • If you have an infection in our ear or any other ear problem, resist the urge to descent headfirst. Instead, go down feet first.
  • Practice equalization daily on dry land so it gets easier for you even while underwater.
  • Avoid using tight headgear while going underwater
  • If you experience even the mildest symptoms of barotrauma, stop diving immediately and signal your buddy. Continuing with your dive will only make the injury worse.

Globo Surf Overview

Ear barotrauma is a common condition among scuba divers. Good news? It can be avoided! Just learn how to equalize properly, dive safely, and most importantly, take care of your ears.

Avoid diving when you have a cold or any ear-related problems. Always seek advice from your doctor before planning a diving trip to avoid stress and anxiety as well as future health problems.

More Scuba Reviews:


  1. Ear Barotrauma, healthline.com
Globo Surf
My name is David Hamburg. I am an avid water sports fan who enjoys paddle boarding, surfing, scuba diving, and kite surfing. Anything with a board or chance I can get in the water I love! I am such a big fan I decided to start this website to review all my favorite products and some others. Hope you enjoy!