My ear hurts when I'm descending — what should I do?

STOP.

If your ear hurts and won't clear, stop descending — right now, before anything else. We stop first and ask questions second, because the one thing guaranteed to make ear pain worse is the next foot down.

Here's the thing to carry with you: discomfort is information, not an obstacle. Most of life, you push through it. Underwater, it's the opposite — discomfort is the body's signal, and your job is to listen, not override. Your body doesn't lie. When the rest of you wants to keep going — the eagerness, the buddy already dropping down the line, the part that doesn't want to be the one who calls it — the body is the one party in the dive that won't keep your secret. The pain is its confession, the truth your ego was trying to bury. Believe it.

Why it hurts — the simple version. Your ear hurts because the pressure outside it and the pressure inside it don't match. As you descend, the water pressure climbs fast, and the little pocket of air behind your eardrum doesn't keep up — so the eardrum gets pushed out of balance. That's the whole of it. Which means the whole job is simple too: make the two pressures equal again.

The cross-section shows where everything sits; panels A–D zoom into the dashed box, simplified and not to scale. Water fills the ear canal on the outside of the eardrum; a small pocket of air sits behind it, in the middle ear, connected to your throat by the Eustachian tube. The arrows show how hard each side is pushing. With the tube open (A, B), air moves through it and the two sides stay equal — going down you push air in; coming up it vents out on its own. Block the tube (C, D) and the two sides can't meet. In C, coming up a few feet takes pressure off the outside and lets the drum relax. D is different. The air behind the drum was equalized for depth — say 60 ft (18 m), the deepest point of the dive. Then the tube blocks. As you come up, the water pressure in the ear canal falls, but the trapped air stays at its 60-ft pressure, so now the inside pushes harder than the water, and every foot up makes the difference bigger. A descent you can always abandon: stop, go up, try again. An ascent you cannot abandon — sooner or later you have to reach the surface.

There are only two ways to do that. You can add a little pressure inside — pinch your nose and blow gently, swallow, work your jaw — or you can take pressure off the outside by going up a few feet. That's it. Everything below is just when and how gently.

Equalize early, and often. This is the rule that prevents almost every ear problem: clear early and clear often, before you ever feel a thing. Start at the surface, and keep doing it gently every few feet on the way down. Because here's the part new divers learn the hard way — the moment you feel pain, you're already late. The squeeze has set in, and you won't clear it easily at that depth. You don't wait for pain to remind you to equalize. You stay ahead of it. (DAN's Beat the Squeeze guide walks through the techniques in detail.)

Never force it. This matters enough to say plainly: once an ear isn't clearing, do not crank a hard, forceful blow to win the argument. A violent Valsalva against a stuck ear can injure the inner ear — a far more serious problem than a scrubbed dive, and one that can be permanent. Gentle, early, often. Never hard.

If pain catches you anyway, the fix is calm and simple: go up a little, clear where it's easy again, and come back down slowly, equalizing the whole way. If it still won't clear — that's the end of the dive. No shame in it. The reef will be there tomorrow.

And you never do this silently. The moment you have a problem, tell your buddy and your instructor — with the hand signal you agreed on before you splashed, because down there you can't say it out loud. This isn't optional and it isn't embarrassing; it's how a team works. When one diver has a problem, both divers have a problem: drop behind wrestling with an ear while your buddy keeps descending, and now there are two problems — your ear, and a separated team. So you signal, you go up together if you need to, and you sort it as a unit. Silence is how a small thing becomes a big one. (It's the same truth as sharing gas: you dive as one unit, not two solo divers who happen to be near each other.)

Most of the time, it's just a cold. If you can't clear, the usual culprit is congestion — a head cold or allergies swelling the tubes shut (Figure 1, C). That's not your body failing; it's a bad day to dive. Don't dive congested. Heal up and come back — it sets up a trapped-gas problem on the way up, too, so it's not worth pushing.

The squeeze has a mirror image — and it's the dangerous one. Everything above is the descent squeeze, where the escape is easy: you go up. But the same thing happens in reverse on the way up — air in the ear expanding as the pressure drops, with nowhere to vent if the tube has swollen shut (Figure 1, D). That's a reverse block, or reverse squeeze, and it's the one to fear, for the reason this whole site keeps circling back to: you can always abort a descent, but you can never abort an ascent. A descent squeeze you escape by going up; a reverse block you can't — you have to surface eventually, and dropping back down only borrows time you don't have.

Which is why decongestants are not a do-it-yourself fix. It's tempting — a cold has your tubes shut, a pill opens them, you get down fine. The trap is timing: if the medication fades at depth, it can leave you in a reverse block on the way up, turning the safe problem into the dangerous one. Nasal sprays add rebound congestion as they wear off, and decongestants carry their own side effects and an oxygen-toxicity question on deeper or enriched-gas dives. So this is never a grab-and-go call. If a decongestant has any place in your diving, it's one a physician chooses with you — the right type, a duration that outlasts the dive, tried on land first and never for the first time while you're gearing up — and you tell your instructor and divemaster what you've taken, especially when traveling. Your team can't account for what they don't know. Most of the time, the honest answer to congestion is still the simplest one: don't dive that day. A pill that lets you bully your way down can hand you the one problem you can't bully your way back out of.

And if it never clears? If you're healthy and still can't equalize, dive after dive, see a doctor first — sometimes it's something an ENT can sort out, and it's worth ruling that out before you conclude anything. But sometimes it isn't, and this is the honest part most people won't tell you: not all bodies are the same. In all my years teaching, I've had two students who tried and tried and simply could not equalize. I told them the kind, true thing — find another hobby. That isn't failure. It's fit. For most people diving fits fine; for a rare few, it doesn't, and forcing it isn't brave, it's just harmful.

You can always choose another great hobby. You cannot choose another body. Protect the one you've got.

References

• Divers Alert Network. Middle-Ear Barotrauma (MEBT).
• Divers Alert Network. Beat the Squeeze: Equalize Like a Pro (Smart Guide).
• Divers Alert Network. Ears and Diving (DAN Dive Medical Reference, 2020).
• Divers Alert Network. Decongestants and Diving (research study).
• scoooba — Pressure tool.