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A Most Common Ear Injury Most Divers Have Never Heard Of

Freediving instructor trainer and coach Ted Harty discusses the ear injury that most scuba and freedivers have likely suffered and didn’t even know what to call it. Just say, Klaatu Barada…err, Barotitis Media?

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by Ted Harty

Header image by Lorenzo Mittiga

Photo courtesy of Ted Harty

I’m going to share with you what is, in my opinion, the most common ear injury in diving; it’s so common that many people, myself included, didn’t even realize it was a diving injury.

By way of background, my name is Ted Harty and I’m the founder of Immersion Freediving, my pride and joy Freediving Safety, and my new podcast Freedive Live. I’m a Performance Freediving International (PFI) Instructor Trainer, PADI Staff Instructor, and competitive freediver. I’m also a past USA Freediving Record Holder, and I’ve been involved as a freediving and scuba instructor since 2005.

When I give a presentation to a group of divers (scuba or freedivers) I often start with the following prompts:

  • Raise your hand if you have ever felt like there was water in your ear that will not come out after a dive.
  • Raise your hand if you have ever noticed your hearing in one or both ears feels muffled after a dive.
  • Raise your hand if you have ever noticed that if you go diving 2-3 days in a row it gets harder and harder to equalize.

    If I have a hundred people in the audience I expect to see at least ninety hands raised.

As a dive instructor this used to happen to me all the time. I’d get back on the boat and feel like there was water in my ear.  I’d start banging my head to try to get the water out. The captain would tell me, “no, no, you have to jump up and down and hit on the other side of the head and then knock it out.” My captains were always so helpful!

It wouldn’t work, and I couldn’t get the water out, so I go buy some Swim-EAR; it says it gets the water out right on the bottle.  I’d use it but that wouldn’t work either. 

Photo by Andrei Voinigescu.

I’d often notice on the boat trip back to the dive shop my hearing was muffled in the same ear. When I would get home and go to bed, I’d think, I’m gonna get this water out, I’m going to sleep with that ear down so the water can drain out. What I didn’t know is the reason none of this worked was because it wasn’t water in my ear.

Photo courtesy of Ted Harty

The Most Common Ear Injury in Diving: Barotitis Media.

I was regularly getting barotitis media, but I had no idea what it was, or that it was an ear injury. Had I gone to an Ears, Nose & Throat (ENT) doctor, they would have scoped my ear and said the blood vessels in my eardrum were enlarged, and told me I have barotitis media.

The Swim-EAR wouldn’t work because there was blood in my eardrum, not water in my ear. It was actually blood in my tympanic membrane (eardrum). In fact, instead of putting the bad ear down when I was sleeping, I should have placed my bad ear pointing up so the blood could drain down the eustachian tube.

As a busy dive instructor in the Florida Keys, I regularly dive 10-14 days straight.  I frequently get the water-in-my-ear feeling, or feel my hearing muffled after diving; it  happens to me all the time. In fact, if my students came to me complaining of water in their ears, I’d just tell them it was part of diving and not to worry.

I had no idea that this was an actual injury to my ears.

Photo by Andrei Voinigescu.

Why is This Happening?

Let’s go back to that same room of 100 divers.  If I asked that same group “when do you equalize your ears?” I would expect most of them to say, “When I feel pain or pressure in my ears.”

Most people wait until they feel pain or pressure in their ears and use that as the cue to equalize. Let’s talk about what happens when you do this.

As you dive underwater, the water pressure pushes in on your ear drum. This causes it to bend in. This is what causes the feeling or pain or pressure.  You then equalize (hopefully via the Frenzel Method of Equalization ) and then the ear drum goes back to normal.  Then, as you keep descending, this happens again and again throughout your dive.

At some point your body says, “Hey, you are terrible at this; you shouldn’t be letting your eardrum bend in like that.” Then the body decides since you won’t take care of it, it will. Then the body fills the eardrum with fluid so that the eardrum is less flexible and won’t bend in as much. That fluid is, of course, blood. 

That’s why the ENT will see the blood vessels inflamed when they scope your ear.



How to Stop This From Happening

The solution to stop this from happening is extremely simple. In fact, it’s so simple I’m sure you have heard it so many times it probably ceases to have any meaning.

Equalize BEFORE you feel pain or pressure in your ears. Equalize early and often.

Photo by Lorenzo Mittiga.

My deepest freedive is 85 m/279 ft, and when I dive that deep I feel zero pain or pressure in my ears, which people find hard to believe. Considering that I equalize every other kick, how could I feel any pressure or pain at all?

Photo courtesy of Ted Harty

This is even more important if you are a freediver. Consider how fast a freediver descends compared to a scuba diver and how many more descents a freediver makes compared to their scuba counterpart. I believe freediving is harder on the ears than scuba due to the number of fast ascents and descents.

If you notice it gets harder and harder to equalize after diving for multiple days, this is often why.

The bottom line is this: if you regularly feel like there is water in your ears, or if your hearing is muffled, or if you notice it gets harder to equalize after multiple days of diving, this is likely due to, in my opinion, the most common ear injury in diving:  barotitis media. As always, I would suggest getting an ENT to look at the ear and follow their advice.

By the way, it is possible to just have water in your ears. But when divers tell me they have these symptoms and nothing fixes it, in my experience, it’s more than likely barotitis media.  I’ve had water trapped behind some ear wax before and that, of course, actually is just water in the ear.  Ear wax removal drops can fix that up if you suspect that.

Prevention is as simple as equalizing before you feel pain or pressure in your ears.  Stop using pain or pressure as the cue to equalize. Equalize BEFORE you feel the need to equalize.

I’ve had hundreds of students say this one simple tip made a big difference in their diving. I hope you find that this helps!

Additional Resources:

InDepth: Should Tech Divers Be Thinking More About Equalization —Like Freedivers Do? by Charly Stringer

InDepth: Is Freediving Safe by Ted Harty

Podcast: Freedive Live (or find it wherever you get your podcasts)

Immersion Freediving: Online Freediving Classes


Ted Harty began his professional underwater career as a Scuba Instructor for PADI, NAUI, and SSI in 2005. In 2008 he took his first freediving class with Performance Freediving International. After that course, he wanted to go freediving instead of scuba diving on his days off, and realized his passion was freediving. In 2009, Ted took PFI’s first official Instructor program, and immediately started working for PFI helping Kirk Krack and Mandy Rae-Kruckshank teach courses all across the USA.

Ted went to his first freediving competition in 2009 as an overweight, out of shape scuba instructor and progressed from 24-27 m/80-90 ft freediver to 54 m/177 ft in three weeks. After the experience he wondered what he could do if he actually started training. Since that time, he’s broken a USA Freediving record in 2011, won three freediving competitions, and was selected to be the captain of the USA Freediving team in 2012; his deepest dive is 85 m/279 ft.

Lately, Ted has been focusing on spreading his message of safe freediving through www.FreedivingSafety.com, which offers a free online course sharing ches in his in-person classes. He can be reached via Facebook, Instagram, Youtube, and Twitter, @ ImmersionFD. Email: tedharty@ImmersionFreediving.com

Freediving

FREE

This month we take a plunge into the wild world of freediving. You are holding your breath, aren’t you? In our view, the diving community writ large can arguably learn a lot from freedivers…

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Text by Michael Menduno. Header image by Lorenzo Mittiga, who provided photos used through out the FREE story bundle.

Diving into the wild! photo by Lorenzo Mittiga

This month we take a plunge into the wild world of freediving. You are holding your breath, aren’t you? In our view, the diving community writ large can arguably learn a lot from freedivers who have essentially operationalized their knowledge and their ability to manipulate mammalian physiology to significant effect. Today’s top athletes are all pushing beyond 100 meters, even intermediate freedivers are reaching into tech diving depths of 50 m/164 ft and beyond, and five-and-six minute static breath-holds are not uncommon—the men’s record is 11:35 (11 minutes, 35 seconds) and women’s record 9:02, breathing up on air. Nitrox pre-breathing is still in its infancy.

As a result, like the old recommendation for early tech divers: Take a cave diving course whether or not you intend to cave dive!—every tech diver should strongly consider taking a freediving course! Without a doubt, it will increase your depth of knowledge and give you a visceral experience you won’t soon forget—a two and a half to three-minute static apnea breath-hold (three minutes qualifies you for intermediate level) will give you an entirely new appreciation for the power of CO2 and your urge to breathe. I guarantee it!

You may find it surprising that freedivers are every bit as geeky as their tech diving counterparts. A few years ago, I had the opportunity to cover and report on Performance Freediving International’s (PFI) Deja Blue Competition in the Cayman Islands for an Alert Diver freediving story. There I was housed in a condo with the rebreather safety diving team. They were a small team of Canadian tech divers led by Bill Coltart who were tasked with being deep safeties for the event. During the competition, the safeties took turns being stationed at 50-80 m/165-261 ft, depending on the event, armed with a lanyard and lift bag to rescue a freediver in the event of an incident at depth. 

One night, we were sitting around the kitchen table strewn with rebreather equipment, and I took notes as the divers engaged in animated discussions about hyperbaric sensor calibration, the efficacy of hypoxic training, comparative work of breathing, whether cartridges offered advantages over hand-packed scrubbers, and the accuracy of temp sticks. After a time, I was curious to know how the freedivers were faring, so I walked next door to the athlete’s condo.

So many fish, so little time.. Photo by Lorenzo Mittiga

To my delight, a half dozen competitors were sitting around the kitchen, watching videos from the day’s dives and geeking out on their equipment as well, in this case their bodies. Their discussion ranged from sharing Frenzel equalization secrets, the optimal depth for moving a mouthful of gas from their lungs to their mouth on that 80 m/262 ft dive in order to equalize, their preferred Mucinex regiment, the agony and ecstasy of doing negative statics, their last samba i.e., LMC (loss of motor control), and their plan to break their PB (personal best) on tomorrow’s dive. It was clear—they were every bit as geeky as their tekkie counterparts.

In this issue of InDepth, we offer you a curated selection of freediving stories that we thought might be of interest to tech divers, beginning with a Wim Hof-inspired story by Sabrina Figliomeni titled, “Freezedivers: What Doesn’t Freeze You Makes you Stronger.” Beware: it will potentially make your blood run cold, even if you’re wearing your RF1!

Next science writer Reilly Fogarty tackles the issue, “Do Freedivers Get Bent?” and explores what we know and we don’t know about breath-hold DCS. The answer is yes btw! French adventure writer Florine Quirion introduces the next innovation in freediving biometrics in, “Listen Up: Freediving Is About to Enter a New Era if Oxama has a Say!” Then we dive into Ted Harty’s Freediving Summit, with a pair of reports, “How Do Competitive Freedivers Stay Safe?” by tekkie turned freediver Dean Laffan, and Handling The Pressures of Competitive Freediving by freediving freelancer Charly Stringer. 

We conclude with some resources on Technical Freediving i.e, breath-hold dives conducted with nitrox pre-breathing, and a The Diver Medic’s new DAN Europe-approved Freediving Emergency Medical Responder course.

Finally, a special thanks to Bonaire-based photographer extraordinaire Lorenzo Mittiga for supplying us with a bevy of freediving bella foto. Grazie Lorenzo! That said, I suggest that you do a good breathe up and dive right in.—M2 


Do Freedivers Get Bent?

by Reilly Fogarty



Additional Resources

Technical Freediving

Kirk Krack and John Hullverson about to conduct mixed gas freediving operations on the Nippo Maru, Truk Lagoon.

The freediving community is the latest community to begin applying mixed gas technology to improve their safety and performance. It’s fair to say that at this stage mixed gas freediving, specifically nitrox freediving, is still in its infancy, and only used by innovators like freediving pioneer Kirk Krack, who has used nitrox pre-breathes successfully in film work on James Cameron’s Avatar series, his colleague John Hulverson and others. However, this will likely change as freedivers learn about and are able to experience the benefits of nitrox pre-breathes. Watch this space.

Tech freediving articles:

DeeperBlue: Technical Freediving: Are Breathhold Divers Ready To Mix It Up? By Michael Menduno (2019)

DeeperBlue: Technical Freediving In Hollywood Revealed by Victoria Brown (2020)

Diver: Technical Freediving in Truk Lagoon By Kirk Krack and John Hullverson (2019)

JHPEE: Covington D, Lee, RH, Toffell S, Bursian A, Krack K, and Giordano C Technical Freediving: An Emerging Breath-Hold Diving Technique, Journal of Human Performance in Extreme Environments: Vol. 15: Iss. 1, Article 3 2019 DOI: 10.7771/2327-2937.1122

Alert Diver: The New Pointy End of Diving by Michael Menduno (2017)

Tech freediving videos and webinars:

The Diver Medic: Kirk Krack – Technical Freediving

Dirty Dozen: Episode #9: Kirk Krack; Technical Freediving in Hollywood with Aron Arngrimsson

OZTek: Video interview with Kirk at Oztek by Michael Menduno 

Freediving Emergency Medical Responder course (FEMR)

This agency-neutral course which was developed by The Diver Medic is endorsed by DAN Europe, many dive doctors and safety specialists, along with Italian freediving champion Andrea Zuccari.

Breath-hold diving is a rapidly growing sport around the world whether freediving for fun or competition freediving. There is also spearfishing, synchronised swimming, and of course, mermaids that freedive professionally for aquariums and events. There are hundreds of thousands of breath-hold divers in the world; many push themselves to their limit, either hunting for food or setting personal records for depth or time. 

However, breath-hold diving has a huge risk factor—possible death or serious injury! This form of diving suffers from an alarming number of fatalities. According to the 2019 DAN Annual Diving Report, there were at least 955 breath-hold diving incidents between 2004-2017, with 73% fatal outcomes—or an average of at least 51 fatalities per year. [Ed.note: This is not the case in freediving competitions] Of course, those are the recorded incidents, what about the unreported ones?

What are the other risks? Blackouts and hypoxic fits, dehydration, blood sugar levels, barotrauma to the eyes, ears, sinus, and lungs, nitrogen narcosis, decompression sickness. Hood squeeze and mask squeeze. Cuts, abrasions to catastrophic injuries like marine life injuries or being accidentally shot with a speargun. Cardiac arrest, heart attack, anaphylaxis, hypothermia, hyperthermia, and shock to name a few. 

Yes, most sports have risks but would you know what to do in an emergency? This is why we want you to be prepared and continue to enjoy the sport you love so much. We encourage you to be safer with the knowledge that can change the outcome of life or death. 

Here are the links to the  courses:

Freediving Emergency Medical Responder

Spearfishing Emergency Medical Responder

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