Be A Better Diver

How to Equalize your Ears

As a diver descends in the water column, the ambient pressure rises, squeezing air pockets such as the inner ear and the mask. Divers relieve mask squeeze by exhaling through their nose and into the mask to equalize the pressure between the inside and outside of the mask. Divers do the same thing with their inner ears by opening the eustachian tubes, which are fleshy tubes about an inch and a half long, running from the back of the nose to your inner ear. The following are some recognized techniques for clearing your ears, though if you successfully use a particular method to pop your ears on an airplane, you should probably stick with that method.

Valsalva Maneuver. Hold your nose and blow air through your throat, into the eustachian tubes and into the inner ear. Blow for no more than two seconds at a time and be careful not to use too much pressure because you can damage the inner ear.

Voluntary tubal opening. Contract the muscles in the back of the roof of your mouth and throat while pushing your jaw forward and down, much like what you might do while stifling a yawn. Tensing and stretching the muscles pull the eustachian tubes open.

Roydhouse Maneuver. This is similar to the Voluntary tubal opening. If you watch your soft palate in a mirror and train the small fleshy protuberance hanging from the soft palate in the back of the throat, the uvula, to rise up and tilt forward, then tense the muscles of the tongue so as to “pop” the eustachian tubes, often by thrusting your jaw forward.

Toynbee. Pinch your nose and swallow at the same time. 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.

Frenzel. Hold your nose and forcefully press your tongue against the back of your throat while making a “K” sound. This action contracts the throat muscles to open the tubes while compressing air against them with the tongue.

Lowry. Combine the Valsalva and Toynbee manoeuvers, hold your nose and then blow against your closed nose while swallowing at the same time. This action pulls the tubes open while forcing air into them which helps them stay open.

Edmonds. Contract the muscles in your throat and soft palate while jutting your lower jaw forward. For a stronger effect, combine the Edmonds with the Valsalva manouver. This action stretches the muscles surrounding the eustachian tubes to pull them open.

Head tilting. Tilting your head stretches the folds around the eustachian tubes so it is easier to open the tubes. If you have difficulty equalizing, try tilting your head from side to side or looking up while performing one of the other maneuvers.

Sometimes mucus can block the eustachian tubes or the tissues can be swollen because of allergies or infections. Everyone knows that smoking is bad for you, and that is particularly true for divers. Smoke irritates the mucosa of the nasal passage and the eustachian tubes and promotes the production of mucus. Milk and other dairy products may also increase mucus production, and should be avoided if you have problems equalizing your ears. Foods that can trigger migraine headaches can also promote congestion. Avoid red wine, chocolate, aged cheeses and foods with additives such as MSG and nitrites. Because dehydration contributes to thick mucus, drinking lots of water may thin your mucus so that it does not prevent equalization.

Divers who have continued difficulty clearing their ears may consider taking pseudoephedrine to dry up the mucus and shrink swollen tissues. Before diving on pseudoephedrine or any other decongestant, however, you should make sure that you tolerate the drug well. It can cause side effects like a racing heartbeat and may complicate nitrogen narcosis and increase your risk of oxygen toxicity if you dive nitrox. Using a nasal irrigation system or Sinus Rinse sounds disgusting, but may be a better treatment than using decongestants.

Otovent sells an auto-inflation kit ( that teaches you how to open your eustachian tubes and can train your ears to open more easily. As the company’s website describes it: “[w]ith one nostril pinched shut, and the balloon mounted nose plug held against the other nostrum, the patient inflates the balloon. Once fully extended, the patient then allows the positive pressure of the balloon to reenter the nose, and swallows, achieving trans-Eustachian tube middle ear insufflation.” The website also claims that the kit has been used for 15 years and is a proven alternative to surgery.

Divers who suffered ear infections as a child may have scars or other physical obstructions that make it difficult to move air through the sinus passages or open the eustachian tubes. Surgery may help, and you should consult an ear, nose and throat specialist regarding your options.

For more information, please see the following:

Dr. Edmond Kay, Doc’s Diving Medicine Home Page, ( and particularly his article on Middle Ear Barotrauma (

Selene Yeager, Equalize Every Time, Scuba Diving Magazine (9 July 2007) (