Pain Management: When to Worry

The most common dive injury, particularly in novice divers, is middle ear barotrauma and, as an instructor, it is important to be able to recognize an ear injury, identify a more serious injury and manage either effectively.
 As you know from your dive training, equalizing techniques enable the higher-pressure air from the throat to enter the middle ear and equalize pressure. Divers who don't sufficiently equalize, or that are congested, can injure themselves.
 If divers surface and describe a feeling of fullness in the ears or crackling sounds (as if there is water or fluid trapped in the ears) they may be experiencing a barotrauma. If this occurs, divers should discontinue diving and you should advise them to see a doctor. Divers should not resume diving until all symptoms are resolved. Injured divers should also be discouraged from further attempts to equalize as this can exacerbate the injury.
 If divers surface complaining of ear pain, facial pain, vertigo, nausea, hearing loss or ear ringing (tinnitus), this could indicate a severe case of barotrauma. The eardrum may be perforated, resulting in pain and possible infection. Divers should discontinue diving and seek immediate medical care.
 Advise divers against treating any dive-related ear injuries with eardrops, as they are alcohol based and designed to prevent an infection called otitis externa (swimmer’s ear). They will not successfully treat the injury and may cause unnecessary pain.
 For more information about ears and ear injuries, you can read the DAN Diving Medicine FAQs on ear equalizing or Stop the Drops! Ear Pain Management. You can also download the Divers Guide to Ears (291 Kb PDF) or take DAN’s online seminar Ears and Diving. If you have any questions, contact the DAN Medical Information Line at 1-919-684-2948.