![]() If you commonly have equalization problems, some doctors recommend practicing equalization on land daily.If you commonly have ear problems, descend feet first and head up.This provides a cushion of air in the middle ears, pre-opens the eustachian tubes and gives you a margin of error in case you neglect an equalization in the first few feet. Equalize once on the surface before descending.The eustachian tubes may be congested or swollen and will not allow for efficient equalization. Muffled hearing, dizziness, popping or crackling sounds while moving the jaw (caused by air entering accumulated fluid in the middle ear), soreness of the eustachian tubes and ears, squeaking noises during equalization on subsequent dives (caused by inflamed eustachian tubes), and fluid leaking into the throat from the eustachian tubes are all signs of a middle ear barotrauma. ![]() Divers experiencing a persistent feeling of water in their ears after a dive would be well advised to be examined by a doctor and to not dive until sensation subsides. This sensation is caused by the accumulation of blood and body fluids in the eardrum and middle ear, not by water in the outer ear. After the Dive: Mild middle ear barotraumas may be recognized after a dive by the feeling of "fullness" or "water in the ears'' that cannot be relieved.Middle ear barotraumas can lead to inner ear barotraumas (which are much more serious) by exerting pressure on the round and oval windows. This sensation is usually followed by a rush of coolness as water flows into the middle ear. Divers who have thus perforated an eardrum report a build-up of pain and pressure and then a feeling of relief as the eardrum bursts. If a diver continues to descend without equalizing, the vacuum in his middle ear cavity may eventually pull on his eardrum to the point that it bursts. I have also experienced soreness and pressure in my eustachian tubes as they begin to collapse from the negative pressure. On Descent: Divers experiencing a middle ear barotrauma on descent report a build up of pressure and eventually pain, accompanied by an inability to equalize.Signs and Symptoms of a Middle Ear Barotrauma On ascent, the inability to equalize the middle ear air space can cause a build-up of excessive pressure, flexing the eardrum outwards. A middle ear barotrauma may occur on descent, when a diver's inability to equalize causes a vacuum in the middle ear, sucking the eardrum and tissues in the middle ear and eustachian tubes inwards. Causes of a Middle Ear Barotrauma. A middle ear barotrauma occurs when a diver cannot equalize the air pressure in his middle ear with the surrounding water pressure.A series of three connected bones called the "ossicles" connects the eardrum with the oval window, transferring sound to the inner ear. The eustachian tube connects the inner ear to the back of the throat, allowing a diver to equalize the pressure in the middle ear with the surrounding water pressure by adding or venting air through the eustachian tube. The Middle Ear. The middle ear is an air-filled chamber separated from the outer ear by the eardrum and the inner ear by two thin, tissue-covered openings called the round and oval windows.To prevent future outer ear barotraumas, a diver should avoid the use of tight-fitting hoods and earplugs, and make sure his outer ears are free of wax and other blockages. Treatment and Prevention of an Outer Ear Barotrauma. Unless an outer ear barotrauma has caused a middle ear barotrauma, the burst blood vessels or damaged skin of an outer ear barotrauma will generally heal themselves. ![]() Signs of an outer ear barotrauma may include small amounts of blood trickling from the ear canal after the dive (from burst blood vessels in the outer ear). In extreme cases, the distortion of the eardrum from an outer ear barotrauma can cause a middle ear barotrauma. Divers experiencing an outer ear barotrauma have reported pain and difficulty equalizing during descent caused by the distorted eardrum. This vacuum sucks the eardrum outwards and distends the blood vessels and skin of the outer ear.
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