Ear Pain After Freediving: Causes, Care and When to See an ENT

Ear pain after freediving usually comes from one of two places. Pain in the ear canal that gets worse when you tug your earlobe or press the small flap in front of your ear points to swimmer’s ear, an infection of the outer canal. A dull ache, fullness or muffled hearing after a dive where your ears were hard to clear points to middle ear barotrauma. Less often, dizziness, ringing or sudden hearing loss signals an inner ear injury, which needs an ENT the same day.

Your ears are the most-used and least-thought-about bit of freediving kit. A little daily care keeps them working through a whole trip.

A quick map of the ear

It helps to know which part is complaining.

• Outer ear: the visible ear and the canal leading to the eardrum. It is lined with skin and exposed to whatever water you are in.
• Middle ear: the air-filled space behind the eardrum, connected to the back of the nose by the Eustachian tube. This is the space you equalise.
• Inner ear: fluid-filled, holding the cochlea for hearing and the organs of balance. It is separated from the middle ear by two thin membranes, the oval and round windows.

Each part has its own typical freediving problem.

Swimmer’s ear (otitis externa)

Swimmer’s ear is an infection of the skin of the ear canal. Water sits in the canal, the skin softens, the protective wax gets washed away, and bacteria or fungi take hold. Warm, humid, tropical conditions suit it perfectly, which is bad news during a week of two or three sessions a day on an island trip.

Typical signs:

• itching inside the ear, often first
• pain when you pull the earlobe or press the flap in front of the canal
• a swollen, tender canal and a blocked feeling
• discharge and muffled hearing

Swimmer’s ear won’t clear if you keep diving through it. Stop diving and see a doctor. Treatment usually involves prescribed ear drops, and the right choice depends on whether your eardrum is intact, so don’t put random drops into a painful ear.

Daily ear care on a dive trip

• Drain after every session. Tilt your head to each side and gently pull the earlobe to let water run out.
• Dry the outer ear. Use the corner of a towel on the outside only.
• Use a hair dryer on a low, cool setting, held well away from your ear, if water still feels trapped.
• Skip the cotton buds. They scratch the canal and push wax deeper.
• Ask about drying drops before you travel. Some divers use them after each day, but they don’t suit everyone, especially if you have had a perforated eardrum or grommets, so get a doctor’s advice first.
• Wear a hood if your ears are prone to trouble. Our post on freediving wetsuits for Indian waters covers hoods for warm water.

Specialist care can be a ferry ride or a flight away from the more remote islands, so plan ahead, whether you are heading to the Andaman Islands or further afield.

Middle ear barotrauma

This is the most common ear injury in freediving. When you don’t equalise in time, water pressure pulls the eardrum inwards. Small blood vessels in the eardrum and middle ear lining leak, and fluid or blood can collect behind the eardrum. In more severe cases the eardrum tears.

Signs include:

• pain during the descent that you pushed through
• fullness, crackling or muffled hearing afterwards
• sometimes a little blood from the nose, which can drain down the Eustachian tube

A perforated eardrum usually announces itself with a sharp pain followed by sudden relief. If cold water then enters the middle ear, it can cause intense vertigo underwater, which is dangerous on a breath-hold. Hold the line, let your buddy guide you up, and end the day there.

Middle ear barotrauma is almost always preventable. If it keeps happening to you, our list of reasons you can’t equalise is worth working through before your next trip.

Inner ear barotrauma: the one that can’t wait

Inner ear barotrauma usually follows forceful equalising, most often a hard Valsalva against tubes that won’t open. The pressure is passed through the fluids of the head to the inner ear, and the round or oval window can tear, letting inner ear fluid leak.

Signs, often starting during or soon after the dive:

• vertigo, a spinning sensation, sometimes with nausea or vomiting
• ringing or roaring in the ear (tinnitus)
• hearing loss, which may be sudden or develop over hours
• a feeling of fullness that won’t clear

Safety: Vertigo, ringing or hearing loss after a dive is a reason to stop diving and get to an ENT or emergency department the same day. Early assessment matters for your hearing. Don’t wait to see if it settles, and don’t keep trying to equalise or blow your nose hard in the meantime.

Surfer’s ear (exostosis)

Surfer’s ear is a slow growth of bone in the ear canal, linked to years of repeated exposure to cold water and cold wind. The bony lumps gradually narrow the canal, trap water and make infections more likely. In severe cases they are removed surgically.

Indian waters stay warm through most of the year, so this is a smaller concern here than for cold-water surfers. If you train in colder water abroad, or spend a lot of time on windy boat rides with wet ears, a hood is a sensible habit.

Which ear problem is it?

What you notice	Likely cause	What to do
Itchy, then painful canal; hurts to touch the ear	Swimmer’s ear	Stop diving, see a doctor
Pain on descent, fullness or muffled hearing after	Middle ear barotrauma	Stop diving; see a doctor or ENT if it doesn’t settle
Sharp pain then relief, with vertigo or blood	Possible perforated eardrum	Stop diving, keep the ear dry, see an ENT
Spinning, ringing or hearing loss after a dive	Possible inner ear barotrauma	ENT or emergency care the same day
Brief dizziness on ascent that settles quickly	Alternobaric vertigo, sometimes a reverse block	End the session; see an ENT if it repeats
Ears blocked and dull for days after a cold	Congestion, fluid behind the eardrum	No diving; see an ENT if it lasts

When to book an ENT appointment

See an ENT if you have:

• any vertigo, ringing or hearing loss after diving (the same day)
• ear pain that lasts more than a day or two after a dive
• discharge or blood from the ear
• one ear that never equalises properly, even after working on technique
• swimmer’s ear on trip after trip

A routine visit is also worthwhile before you start training seriously for depth. An ENT can check your eardrums, look at your nose and throat, and give you a baseline hearing test to compare against later. If a cold is your usual trigger, read why freediving with a cold isn’t worth the risk.

The freediving.in community is coming soon. Stay tuned.