- Ear health is essential for diving safety — ears control balance, orientation, and hearing underwater, yet are often overlooked in dive safety checks.
- Pressure changes can cause barotrauma — improper equalisation during dives can lead to eardrum injuries, middle-ear strain, or long-term damage.
- Noise exposure adds hidden risk — repeated exposure to engines, sonar, or underwater blasts can contribute to hearing fatigue or permanent hearing loss.
- Routine hearing checks help prevent complications — regular audiology assessments detect early signs of damage and guide safe diving practices.
- Proactive care protects your diving future — maintaining healthy ears ensures comfort, confidence, and safety during every dive.
Diving and Auditory Health – Why Ear Checks Matter
When people talk about dive safety, they usually focus on air supply, buoyancy control, or decompression limits. What often gets overlooked is the health of the ears and hearing system — they play a crucial role in balance, orientation, and overall safety underwater.
Your ears are responsible for much more than hearing. They help you maintain equilibrium, detect subtle sounds underwater, and keep you aware of your surroundings. Because diving places the ears under unique pressure stresses, it’s important for every diver to include auditory health as part of their regular dive safety routine. Ear injuries account for up to 72% of all diving-related injuries, with 47% of diving injuries attributed ear barotrauma, and/or ear infection1,2.
Routine hearing and middle-ear checks can identify early signs of change before symptoms appear, help guide safe dive practices, and prevent long-term complications that could affect both hearing and diving enjoyment.
How Diving Affects the Ears
Pressure changes and barotrauma risk
Every descent and ascent exposes your ears to changing pressure. These fluctuations place mechanical stress on the middle ear (the space behind the eardrum), and the delicate membranes of the inner ear.
If the pressure isn’t equalised correctly, the eardrum and middle ear tissues can stretch or even tear – a condition called barotrauma. This can range from mild discomfort and congestion to more serious injury such as eardrum rupture2,3.
Research shows that divers who practise proper equalisation techniques rarely develop permanent ear damage4. However, repeated diving without adequate surface recovery, or frequent equalisation difficulties, can gradually strain the middle ear.
While some studies have found no lasting changes in hearing thresholds among regular recreational divers5, others suggest that repetitive microtrauma can affect middle ear function if pressure problems occur often or are severe6. The consensus is simple: good equalisation habits and controlled diving profiles are key to protecting your ears.
Noise and acoustic exposure
In addition to pressure, divers are sometimes exposed to noise from boat engines, compressors, sonar, and/or underwater equipment. Over time, these sounds can contribute to hearing fatigue or noise-induced hearing loss, particularly when combined with barotrauma5.
Sudden loud underwater sounds – such as blasts or explosions – can also cause acoustic trauma to the inner ear7.
Vascular and decompression effects
A rare but serious condition known as inner-ear decompression sickness (IEDCS) can occur when nitrogen bubbles form inside the inner ear during or after ascent. These bubbles may damage the cochlea or balance organs, leading to sudden hearing loss, tinnitus, or vertigo4. Even smaller, temporary changes in inner-ear blood flow during pressure shifts can make the ear more vulnerable to injury7.
Individual risk factors
Some divers are naturally more prone to ear problems than others. Risk factors include:
- Difficulty equalising or known Eustachian tube dysfunction
- History of ear infections or ear surgery
- Nasal congestion, allergies, or sinus issues
- Diving while unwell with a cold or flu
- Rapid or forceful descents
- Smoking or vascular problems that affect circulation8
Why Routine Hearing Checks Matter
Having your hearing and ear health checked regularly is one of the simplest ways to stay dive-fit and protect your long-term auditory wellbeing.
A baseline audiology evaluation before you start diving – or when returning after a break – provides a reference point for future comparisons. Regular monitoring every 1 to 2 years helps identify early changes before you notice symptoms.
If changes occur, audiology re-assessments are necessary to determine whether the problem involves the middle ear or the inner ear; and if the issue is temporary and treatable, or require further medical management5.
For commercial and occupational divers, hearing assessments are generally part of medical clearance requirements. But even for recreational divers, maintaining healthy hearing means being able to detect important underwater cues – from your buddy’s signals to safety alarms.
Practical Tips for Protecting Your Ears
- Get a baseline audiology assessment before you begin diving or after a long break.
- Repeat every 1 to 2 years or sooner if you notice any ear symptoms.
- Stop diving immediately if you experience ear pain, fullness, ringing, hearing loss, or dizziness, and seek professional evaluation4.
- Avoid diving when congested or during respiratory illness.
- Minimise noise exposure from compressors, boats, or loud environments topside5.
- Practise gentle equalisation – never force pressure (see Article 3 on Equalisation Techniques).
- Consult an ENT and/or audiologist if you’ve had ear surgery or previous auditory problems, before returning to the water8.
Takeaway
Protecting your ears is just as important as maintaining your dive gear. The combination of pressure, noise, and environmental exposure makes the ears especially vulnerable – but most issues are preventable with awareness and proactive care.
By including regular ear and hearing checks in your dive safety routine, you’re not just protecting your hearing – you’re preserving your ability to dive comfortably, confidently, and safely for years to come.
Include regular ear and hearing checks in your dive safety routine
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REFERENCES:
- Helfrich, E. T., Saraiva, C. M., Chimiak, J. M., & Nochetto, M. (2023). A review of 149 Divers Alert Network emergency call records involving diving minors. Diving and hyperbaric medicine, 53(1), 7–15. https://doi.org/10.28920/dhm53.1.7-15
- Nofz, L., Porrett, J., Yii, N., & De Alwis, N. (2020). Diving-related otological injuries: Initial assessment and management. Australian Journal of General Practice, 49(8), 500–504. https://doi.org/10.31128/ajgp-01-20-5191
- Chapter 2: Injuries. (n.d.). Divers Alert Network. https://dan.org/health-medicine/health-resource/dive-medical-reference-books/ears-diving/ear-injuries/
- Stieler, O., Wawrzyniec Loba, Wojciech Gawęcki, Urbaniak-Olejnik, M., Majewska, A., Wojciech Warchoł, & Dorota Hojan-Jezierska. (2021). The impact of regular diving on the condition of the middle ear. International Journal of Occupational Medicine and Environmental Health, 34(6), 779–788. https://doi.org/10.13075/ijomeh.1896.01735
- Livingstone, D. M., Smith, K. A., & Lange, B. (2017). Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care. Diving and hyperbaric medicine, 47(2), 97–109. https://doi.org/10.28920/dhm47.2.97-109
- ONeill, O. J., Brett, K., & Frank, A. J. (2021). Middle Ear Barotrauma. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499851/.
- Scarpa, A., Ralli, M., De Luca, P., Gioacchini, F. M., Cavaliere, M., Re, M., Cassandro, E., & Cassandro, C. (2021). Inner Ear Disorders in SCUBA Divers: A Review. The journal of international advanced otology, 17(3), 260–264. https://doi.org/10.5152/iao.2021.8892
- Edmonds, C., Bennett, M., Lippmann, J., & Mitchell, S. (2015). Diving and Subaquatic Medicine. CRC Press.