New or Experienced Divers Need to Remember

©1996, Robert E. Lee, All Rights Reserved

How often do you get drilled in training to remember that every dive requires the same level of attention to detail that your first dive did even though it might be your 1000^th dive?

Perhaps we all expect that after dozens of dives we’ll have made it a habit to pay attention. I wish it were so. In twenty years of diving without any serious injury beyond a few minor cuts on coral or jellyfish stings, I figured I was immune from the more serious injury of ear squeeze. After all, how hard is it to tell if you are equalizing properly on the way down or back up?

Guess what, it can sometimes catch you when you least expect it. On a recent dive trip to Key West I was excited about the start of a full day of diving, my ninth through twelfth dives which were going to finish off my dive vacation. My ears had concerned me earlier in the week, I had just recovered from an infection a few days prior to the trip, but in all of the dives I had no trouble equalizing, this morning should have been just the same.

The first dive was planned at a depth of 40 feet or less, so I wasn’t going through much more than an atmosphere of additional pressure. In the water I go, landing with all my gear in place and then giving the dive master the OK sign. I located my dive partners and signaled to start the dive. Down they went, with me in pursuit. Five feet, everything fine, just a few seconds into the dive, ten feet, still doing all right, seems like there is no need to worry about my ears, no squeeze there.

But wait a minute, I haven’t even hit 15 feet and I hear a pop in my right ear. My first thought went straight to the idea that my ear drum had popped open, but it didn’t hurt like I thought it should. I tested my theory that it had been perforated by gently trying to equalize. The proof came as I felt a tickling in my right ear out canal, where I felt tiny bubbles floating out of the ear.

What to do when you have four exciting dives planned and this happens at the outset. First I’ll give you the right answer and why, then I’ll tell you what I did and what it cost me in making a bad decision.

Perforation of the ear drum is a serious dive injury that should remove you from the dive right away. The extent of injury can range from a tiny, single hole to a full tear in the ear drum. While not likely to let water into your inner ear, it can happen given the difference in pressure if your are descending with a perforated ear drum.

Symptoms underwater will include pain, bubbling in the ear, possible disorientation and loss of balance as the inner ear is affected by the injury. On the surface you will notice a developing dull pain, possible drainage of clear or bloody fluid. This injury is not life threatening, but it does require medical attention and treatment.

Short term treatment may include antibiotics to prevent infection, decongestants to keep your sinuses clear and obviously, no more diving for a while. Flying after an injury like this is possible, but only under advice from your doctor.

Now to the rest of the story, the wrong way to handle things. I decided that I would manage the injury, meaning that I would monitor my symptoms and decide when I had sufficiently damaged the ear drum that I needed to stop diving that day. I gently continued to equalize, using strictly the pressure provided by equalizing the pressure in my mask. This kept a gentle positive pressure in my ear, leaving me to bubble out of my right ear for the dive.

On the surface I checked the color of the fluid from the ear, seeing if the injury was severe enough to draw blood. I decided that there was no blood, so the problem was less severe than I thought. Over the next three dives (the first one was 31 minutes) I repeated these steps each time.

What happened that day was an increasing dull pain between dives as fluid built up in the ear, finally moving to a slightly bloody stage at the end of the day. I thought I felt good about the decision, after all, we did bag a bunch of lobster and I was eating fine that night.

I went to the hospital as soon as I showered up and cleaned everything out. The doctor pronounced my ear a minor disaster zone, with 4 or 5 very small holes. I got off lucky in that respect. These holes were small enough to repair themselves, a larger tear could have required surgery. I took my antibiotic and then went back to the hotel to see how fast I could get home.

I checked my dive computer for the minimum time to fly, it was 5:20pm the next day and the only flight I could get was at 5:05pm. I bet on the airline running late to take me out of the decompression zone and I won that one. But my ear was getting more congested as I dealt with increased fluid draining out. I had no real problems equalizing on the flight, but the ear hurt as I got home.

The next day I talked with my doctor and changed antibiotics and began an external ear treatment to minimize the infection that was developing. No help there, it took 10 days to get the external ear under control, during which time the drum did heal, and it took another 25 days for the internal infections to be removed from my inner ear and sinuses.

I know now that my decision to continue diving was wrong, it increased the level of infection and trauma on the ear. I paid for it through another month and a half of illness.

The upside of the experience is that through it all I became another excellent story to tell in the classroom of the dangers of violating the guidelines we must follow for safe diving and the reminder that all of us, new and experienced, can fall prey to the simplest of injuries. Remember to use your good judgment and always let a dive go by in deference to your health and the health of everyone else with you. You can always dive another day when your healthy.