"We can usually get 96 to 97 percent of people equalizing without any extraordinary means, like surgery," says Frans Cronje, M.D., executive and medical director of DAN Southern Africa. "It's a matter of finding the right technique as well as addressing underlying factors that may be making equalizing more difficult than it should be."
First, check your technique. Very simply, the "goal" of equalizing is to create pressure inside the ear canal that matches that of increasing pressure from the outside. The only way to do that is through the eustachian tube-a tunnel that runs from the back of your nose to the middle ear space. The eustachian tube is mostly collapsed; but it opens up when your ear space needs to equalize pressure. When you feel that familiar "pop," your eustachian tube has opened to let air in. When you dive, the outside pressure is more extraordinary, so opening the tube takes more work.
As with any big job (and you know if you're reading this, clearing can feel like a big job), it's important to get an early start. That means you shouldn't even wait until you hit the water. Test your ears while putting together your gear and suiting up. You should be able to clear with ease. Once you're in the water and on your way down, clear before you feel discomfort, rather than waiting until you feel pressure. And don't limit yourself to "just pinching and blowing."
"There are many techniques for equalizing," says Cronje. "We all know Valsalva [pinch and blow], because it's the easiest to teach and to try, but you may find you respond better to another method," he says. The following are techniques experts find work best.
How to do it: Everyone knows it; but many people still don't do it quite right. Pinch your nose and gently blow air up through your throat and into the eustachian tubes. The trick is to blow with the right amount of pressure-but not too much, because you can damage the inner ear. You want to blow as hard as you would if you were inflating a large balloon. Blow no longer than two seconds at a stretch.
What it does: Actively opens the eustachian tubes with an increase in air pressure.
Voluntary tubal opening
How to do it: Contract the muscles in your soft palate (the back of the roof of your mouth) and throat while pushing your jaw forward and down. It should feel like yawning with your mouth closed, like you might do when trying to be polite during a boring conversation.
What it does: Tensing and stretching the muscles pull the eustachian tubes open. Some divers get good enough at this technique to hold their tubes open for continuous equalization.
How to do it: Pinch your nose and swallow at the same time.
What it does: Swallowing tenses the muscles in the throat and soft palate to pull the tubes open, while your tongue compresses air against them. This is considered one of the most natural ways to equalize.
How to do it: Hold your nose and forcefully press your tongue against the back of your throat while making a "K" or "ng" sound.
What it does: Contracts the throat muscles to open the tubes while compressing air against them with the tongue.
How to do it: Combine Valsalva and Toynbee: Pinch your nose and then blow against your closed nose while swallowing at the same time. It's tricky to do with a regulator in your mouth. But it can help you feel how the muscles you use to clear work.
What it does: Pulls open the tubes while forcing air into them to ensure they get open and stay open.
How to do it: Contract the muscles in your throat and soft palate while jutting your lower jaw forward. For a stronger effect, combine Edmonds with Valsalva.
What it does: Stretches the muscles surrounding the eustachian tubes to help pull the tubes open.
How to do it: While using other equalizing techniques, tilt your head from side to side (the side being stretched should be easier to clear). Some divers also find it easier to clear their ears if they look up.
What it does: Tilting the head stretches the folds surrounding the eustachian tubes so it's easier to open them.
Trouble Below the Surface
So you've tried jutting, tilting, pinching and blowing and still can't get your ears open. Chances are you have an underlying problem literally blocking the way, says Melissa Pynnonen, M.D. "Like your nose, your eustachian tubes are lined with mucosa, which produces the thick fluid we know as mucus. And like the lining of your nose, the tubes can be swollen and blocked when they're irritated by allergies or infections," she says.
Here's a look at the most common roadblocks to clear ears and how to work around them.
Stuffiness is by far the biggest barrier to ear clearing. Inflamed mucosa in the tubes shrinks the opening, making it harder to force air in and equalize the pressure, and too much sticky mucus can clog the openings, making it nearly impossible to open the tubes no matter what you do. A clear head is the ticket to clear ears. Here's what to do:
Flush 'em out. Nasal irrigation systems like NeilMed's Sinus Rinse (www.unimedprod.com) or Ayr Sinus Rinse (www.bfascher.com) flush out sticky mucus, wash away irritants that inflame your mucosa, and stimulate the cilia (little broom-like hairs) in your nose to help them work better at keeping the passages clean and clear. In a study of 100 divers with ear-clearing troubles, 69 percent of them reported improvement after performing nasal irrigation. "Sixty percent of those who routinely used oral decongestants during diving were able to use less or stop taking the pills altogether," says study investigator David F. Colvard, M.D., of Raleigh, N.C.
It sounds gross. And maybe it is a little. But it doesn't sting, and you feel remarkably better afterward. "Irrigation also works dramatically better than saline sprays because it mechanically rinses out thick or crusted mucus in hard to reach places and reduces swelling in the mucosa, so you have more space for air to move in and out," says Pynnonen, a practicing sinus surgeon.
Drink up. Dehydration contributes to thick, clumpy mucus. "Drinking enough water so your urine is clear will help thin your mucus so it's less sticky and the eustachian tubes will function better," says Cronje.
Snuff the smokes. Anyone who's ever experienced a mucousy smoker's cough knows that tobacco smoke irritates the mucosa and promotes more mucus production. Quitting helps clear your lungs-and your ears.
Bypass the dairy. Milk and other dairy products increase mucus production. "Avoid eating dairy for two days before you dive if you have trouble equalizing," says Cronje.
Avoid additives. The same foods that can trigger migraine headaches also can contribute to congestion and ear clearing woes, says Cronje. Steer clear of red wine, chocolate, aged cheeses and foods containing additives like MSG (monosodium glutamate) and nitrites.
Pop a pill. Although recommended with caution and for no more than three to five days, when all else fails, 60 mg of pseudoephedrine (Sudafed) may do the trick. Be cautious, however; Sudafed can cause side effects like racing heartbeat that don't mix well with diving and can even cause an obstruction of urine in men. Be sure you tolerate it well before diving on it, and don't overdose. Also, because it stimulates your central nervous system, it may interact with nitrogen narcosis and increase your risk of oxygen toxicity. "I would be careful taking it if you are planning dives deeper than 80 feet or using enriched air nitrox," says Cronje.
A lot of people are susceptible to eustachian tube dysfunction, where the tubes are swollen (often after a cold) for weeks or even months. Others just can't get the hang of clearing. In either case, consider trying the Otovent (www.invotec.net), an autoinflation kit that helps treat eustachian tube dysfunction. "It's a nozzle with a balloon that you inflate with your nose. Using it teaches you how hard you need to blow to open your tubes and over time it 'trains' your ears to open more easily," says Cronje. The downside is it's only available online.
If you suffered myriad ear infections as a kid, your eustachian tubes may be scarred. Or you may have a physical obstruction, like a deviated septum making it more difficult to move air through your sinus passages. If your ears are stubbornly shut, see an ear, nose and throat specialist who can help clear the way to easier ear clearing.