Diving can be a truly unique experiences. However, many significant problems may occur in all parts of the ear canal that the diver needs to be aware of.The three different areas of the ear can all be injured during the descent or ascent during a diving expedition.

Barotrauma of the External auditory meatus 

Pain in the external ear is due to the negative pressure which may result in small hemorrhages in the skin of the ear canal and the eardrum. Treatment is not usually necessary; however, diving should stop until healing of the external acoustic meatus is completed.

Otitis externa is an inflammation of the ear canal caused by bacteria. If the ear remains moist from immersion in the water, this moisture, coupled with the warmth of the body, creates an inviting growth area for many microorganisms, especially opportunistic bacteria. 

Barotrauma of the Middle ear

This is the most common injury reported by divers. It should be highlighted that the first 10 to 11 meters below the surface, are the critical threshold for the pressure to equalize in the ears. The diver, who cannot achieve this equalization in pressure, may encounter severe pain, hearing loss and vertigo either immediately after the dive or even a few days later.

The diver will experience  severe pain and sometimes vertigo from labyrinth irritation due to cold water entering the middle ear. When the diver emerges, depending on the severity of the barotrauma, there may be pain, hearing loss, dizziness, and possibly bleeding.

Barotrauma of Inner Ear

This may occur following barotrauma of the Middle ear, or if the pressure in the middle ear is not equalized during descent, the water pressure on the eardrum transfers inward and may damage sensitive inner-ear structures.This injury generally occurs when divers attempt to forcefully equalize their ears. This “hard” blowing over-pressurizes the middle ear and can result in implosive or explosive damage to the round and oval windows, causing a perilymphatic fistula.

Pressure waves alone can cause damage to the inner ear without window rupture. If the rupture occurs, the loss of fluid from inner ear leads to damage of the hearing organ and sometimes of the balance organ.

The  symptoms are hearing loss, tinnitus and  vertigo.