One of the most limiting factors for freedivers is the inability to equalize at depth. One of the most limiting factors for the freedive instructor is to teach students to equalize. To some degree, the process of equalization, or making the pressure on both sides of the eardrum the same, is obscure. Independent of how well you describe the sensations involved with equalization or the actual physiology of forcibly pushing air through the eustachian tubes into the middle ear, it is hard to get someone who cannot equalize to achieve this maneuver. Instructors spend hours hosting equalization workshops, emailing documents and links, and practicing with students until they can hold their nose, close the glottis, use the tongue as a piston and push air into the middle ear. I do not even really understand what I said in the last sentence and I can already equalize!
We preach equalizing the ears early and often to prevent a perforated tympanic membrane (eardrum). But is that enough? It seems to me that most freedivers are under the impression that a busted eardrum is the worse barotrauma they can experience in their ears. As a whole, they also say that the eardrum heals quite easily. Is this barotrauma really an issue if the tympanic membrane really heals so easily? Are there other problems we may be glossing over?
A student of the last PFI course I taught brought up an interesting question that I relayed to my audiologist friend, Bruce, on our way to Lowe’s Home Improvement. The student asked if the pressure change involved with equalization mimics the pressure difference your ear senses when you listen to super loud music, creating hearing loss. I could not answer the question but it left me worried. You see, I can only hear out of one of my ears. I have profound hearing loss in my right ear leaving me with one “good” left ear. I have the left ear tested semi-regularly to detect any hearing loss but have not been tested since Bruce left the country a few years ago. Since he left I have been diving considerably deeper than before. After a long, drawn out explanation he assured me that diving deep, if the diver equalizes properly, will not result in hearing loss. So, if diving deep doesn’t cause hearing loss and if punctured ear drums heal easily, what’s the problem?
The Real Issue
I do not condone perforated eardrums. Let us get that straight. I have had divers tell me to “Just go for it. It’s a record dive!” That’s not me. Maybe it is a question of damaging my one good ear but I don’t feel comfortable pushing equalizations. When equalizing gets tough, I turn around. I encourage all of you to do the same. Be good to your ears. Nobody makes money freediving. You have nothing but your pride hanging on the line so there is no need to cause unnecessary damage to your audio organs.
We have established that, if you do decide to push it, the eardrum will heal fairly quickly. But there are other, more serious barotraumatic injuries that you can suffer if you push the ears. By forcing an equalization, I mean having to push hard after you have neglected to clear your ears at a reasonable rate, you run the risk of causing a perilymph fistula or a round window blow out. Now Bruce sat in the car, explaining the perilymph fistula to me while I tried not to vomit. Sometimes I get a bit queasy thinking about popping blood vessels and membranes. The most disgusting thing in the world is not vomit or blood and guts, its is a simple bruise…yuck! I digress. Basically, very basically, you have three little bones in the inner ear, the hammer, the anvil and the stirrup. The hammer connects to the anvil which connects to the stirrup which lays against a little membrane that separates the inner and middle ear. When you push an equalization you can cause the little membrane to tear, which releases fluid from the inner ear. This release of fluid causes intense vertigo which can last weeks until your body can learn to cope with the imbalance of inner ear fluid. Also, hearing loss is a serious risk associated with a perilymph fistula. Not temporarily muffled hearing as with barotitis media but permanent hearing loss. Hearing loss is not fun guys…trust me. Plug one ear up right now with your finger and talk. Exactly! Get it?
You do not get paid to freedive, no matter who you are. The most anyone gets here in the US is some sponsorship here and there. That’s it. It’s not worth the risk to your ears, or the rest of your body for that matter, to push an uncomfortable situation. Turn early, get to the surface, back off the depth and try again next time with a clear eardrum and clear mind.
Check out really cool illustrations of a round window blow out here.