Having a problem with your ear may prevent you being able to safely undertake SCUBA diving. If in doubt it is better to be safe as the consequences of error can be deadly or can cause permanent life changing symptoms of hearing loss, tinnitus and dizziness.
Problems that can occur when diving ;
Middle ear Barotrauma on descent;
This is common. Discomfort or pain may be noticed at descents of only two metres. If equalisation of pressure is delayed then you may get locking of the eustachian tube where the pressure is tending to prevent the tube from opening. If the dive continues without successful equalisation, then fluid in the middle ear, bleeding into the middle ear and ear drum perforation can occur. Difficulties happen especially in the first 10 metres of depth. In some cases there may be little in the way of symptoms despite signficant barotrauma. If a perforation occurs, rush of water into the middle ear can cause nausea and vertigo which quickly resolves. Diving should be avoided till resolves.
Middle ear barotrauma on ascent;
Clearly more dangerous situation that as above as can prevent ascent but usually follows barotrauma of descent. Results in pain and pressure and/or vertigo due to different pressures in each ear. Symptoms are usually mild but not always. Can lead to ear drum perforation and inner ear damage.
External ear barotrauma;
This can occur if the ear canal is occluded when diving. This is rare and easily preventable causing only mild symptoms.
Inner ear barotrauma;
Always a risk if middle ear barotrauma occurs or high pressures are needed to autoinflate the ear. Middle ear barotrauma is the commonest cause of inner ear barotrauma. It can cause hearing loss, tinnitus and/or vertigo. Inner ear barotrauma can cause a perilymph fistula- leading to dizziness and hearing loss in the ear which can be sudden, slow in onset or fluctuating. It often is noted after surfacing when doing energetic tasks. If suspected a CT scan will often be performed looking for air in the inner ear. Management is typically with bed rest, head elevation and avoidance of straining and operation if no improvement in symptoms after 48 hours.
Facial nerve palsy
This is most commonly observed after middle ear barotrauma and tends to recur.
The following is a list of contraindications to diving- relative and absolute related to ear problems. This is not meant to be exhaustive and is for general information only and should not be regarded as definitive nor should it replace discussing your individual case with your physician/surgeon;
If you are unable to equalise the pressure in your ear then you should not dive. It may be that issues related to this are temporary or can be corrected - treatment of nasal issues and more recently balloon eustachian tuboplasty has been employed effectively in some such cases.
Perforation of the tympanic membrane and presence of grommets and similar ventilation tubes is regarded as an absolute contraindication. However, I have met patients who have dived in this situation without consequence describing bubbles coming out their ear when equalising pressure. It is said that the free divers of SE Asia in some cases deliberately perforate their ears to avoid having to deal with issues related to pressure change.
A very thin ear drum is an absolute contraindication due to the risk of causing perforation when equalising pressure. This is relatively subjective and would also depend on how easy it was to equalise the pressure, as if easy then less of an issue as less pressure in the ear.
Repair of ear drum- if well healed and good ventilation/ able to equalise pressure then this does not represent a contraindication.
Stapes surgery- it has been proposed that if the pressure can be equalised easily then previous stapes surgery is not a contraindication. However, this would remain a significant risk and I would advice against diving if you have had this surgery.
Ossiculoplasty- changes in pressure could result in disruption to the inner ear as the natural protective mechanisms of the ossicular chain are no longer functional.
Modified Radical Mastoidectomy- contraindicated- some divers have reportedly continued in spite of the presence of a cavity, waiting till any dizziness has settled after immersion before continuing and then washing the ear out to prevent infection after completing the dive.
Closed mastoid surgery- cortical mastoidectomy is not a contraindication. Intact canal wall surgery may be possible if no other contraindications apply such as ear implants, poor eustachian tube function, fistula into lateral canal, signficant hearing loss in one ear etc.
Untreated cholesteatoma- this should be carefully assessed by an ENT specialist before considering diving
Stenosis of the ear canal may make ear infections due to otitis externa more likely but is not an absolute contraindication.
Facial palsy secondary to barotrauma- it is inadviseable to dive (as above). Facial palsy due to other causes is regarded as a relative risk
Meniere's disease- active disease should be an absolute contraindication for fear that an attack occurs at depth.
Previous perilymph fistula/ round window rupture - it is inadviseable to dive in this situation.
Episode of labyrinthitis - if is a single episode and fully resolved then diving can resume
Completely impacted wax- can lead to ear canal barotrauma - rare but is easy to avoid by ensuring ears are not completely occluded before diving
Significant hearing loss in one ear- diving poses a risk to hearing in each ear and so if loss of hearing occurs in the ear that you depend on it could cause serious problems in the same way as surgeons are reluctant to operate on the better hearing ear.