29 Apr 2022 | Claudio Di Manao DAN Alert Diver
Equaleasy - Debunking the myths ofequalisation in diving
Anthropological studies on Homo subaquaticus show that members of this species are quick to
learn—at a cost—that their ears play an important role when they go underwater. The most
common underwater accident that occurs with this species is barotrauma. Yet when it comes to
myth-making, the more fanciful stories produced by members of the species seem to relate not so
much to barotrauma, but mainly to how gases affect the body, especially the brain. Stories on the
topic of equalisation and proper hygiene for the ears and nose seem rare. Evolution at work?
"Nowadays divers are well informed; they are thirsty for knowledge"
Dr. Cosimo Muscianisi, ENT specialist, diving and hyperbaric doctor, and passionate technical
diver, has no doubts, “Judging from their questions, and from the terminology they use, we meet
well informed divers at meetings and conferences.”
“Unfortunately, we witness some bad practices, amongst divers and non-divers. Accidentally even
some diver could try to remove some wax by using inappropriate tools like parts of toothpicks and
swabs. The deep insertion of earplugs or headphone rubber parts could require the intervention of
an ear specialist for their removal.”
A careful diver is unlikely to insert in her/his ear canal objects that could permanently damage the
ear, such as keys and pen caps. Yes, as Dr. Muscianisi witnessed, there are people who believe
that the tiny groove on the cap’s bayonet, as that of the keys, is suitable for ear wax removal.
Generally speaking, as divers we don't do such silly things. We make different mistakes.
The grey area
During initial training, divers typically pick up a few ideas about diving physiology. Their knowledge
grows as they continue their education. An entry-level certified diver would be afraid of breaking
the rules; they would hardly dive with a cold or sinusitis. What’s more, because they obey the
sacred instruction in their diving manuals that specifies a reverse block could cause much worse
sorrow than calling the dive, entry level divers avoid using nasal decongestants at all costs. A
diving professional, on the other hand, might take ephedrine derivatives or other orally
administered vasoconstrictors for their long-lasting effect, if in need, despite (and sometimes
wilfully ignoring) a variety of associated side-effects that are incompatible with diving.
Empowered by a handful of notions as it were, diving professionals are typically the most likely to
exhibit an excess of confidence. Like all divers, whether entry level or instructors, they are sorely
tempted to make self-diagnoses, with the help of the infamous “internet consulting”. Most divers,
and an even greater number of non-divers, typically blame a sense of fullness in the ears and
muffled hearing on an excess of earwax, explains Dr. Muscianisi, though in many cases it could be
a symptom of a middle ear problem. A neglected inflammation of the middle ear can lead to a
symptom’s worsening in the mastoid and middle ear area. Conversely, in the case of hitching as
the main symptom, the unsupervised use of corticosteroid drops, or tablets could lead to a
worsening if the case were linked to a fungal infection in the outer ear. The consequences in either
case can be serious, such as permanent damage of the auditory system, or having to hang up
one’s fins for good.
Top of the chart
On the top ten list of underwater misadventures, barotrauma retains the number one spot. It is
hard to find a diver who has never suffered from it. When barotrauma occurs, we all know where to
put the blame: an equalisation mistake, the thoughtless use of decongestants, or diving in not
perfect health conditions, as with some sign of cold. Unfortunately, the sacred training texts offer
little to satisfy divers’ thirst for knowledge on this topic. As a result, most divers only know one or
two equalisation techniques. The more skilled ones know three. However only a tiny fraction of
divers would be able to demonstrate mastery of just one of these techniques.
Many divers are unaware that equalising at depths as shallow as ten metres can be difficult, if not
impossible, without the help of compressed gas from scuba. Many divers are unaware that
equalising head down, feet up can be a challenge. Yet we constantly use our ears, nose, and
throat to breathe, swallow, speak, smell and taste. But we are not fully in control. Maintenance and
control of this area of the body are historically an exclusive domain of opera singers. Unfortunately
for us, opera singers never developed an equalisation course for divers. Can you imagine? But
then most divers would struggle to hit a high C.