Ear clearing, clearing the ears or equalization is any of various maneuvers to equalize the pressure in the middle ear with the outside pressure, by letting air enter along the Eustachian tubes, as this does not always happen automatically when the pressure in the middle ear is lower than the outside pressure. This need can arise in scuba diving, freediving/spearfishing, skydiving, fast descent in an aircraft, fast descent in a mine cage, and being put into pressure in a caisson or similar internally pressurised enclosure, or sometimes even simply travelling at fast speeds in an automobile. [1] [2] [3] [4]
Normally the ears will clear automatically during a reduction in ambient pressure, but if they do not, a reverse squeeze may occur, which can also require clearing to avoid causing injury to the eardrum or inner ear.
People who do intense weight lifting, such as squats, may experience sudden conductive hearing loss due to air pressure building up inside the ear.[ citation needed ][ clarification needed ] An ear clearing maneuver will often relieve pressure in the middle ear, or pain if any.
The ears can be cleared by various methods, [2] some of which pose a distinct risk of barotrauma including perforation of the eardrum:
No single method but the last is considered safest or most successful in equalization of the middle ear pressure. Using alternative techniques may improve the success individually when a technique fails. [9]
The pressure difference between the middle ear and the outside, if not released, can result in a burst eardrum. [10] This damages hearing, [11] and if this occurs underwater, cold water in the middle ear chills the inner ear, causing vertigo. [12] The pressure difference can also cause damage to other body air spaces, such as the paranasal sinuses. [13] This can also be caused by damaged sinus ducts.
To allow successful equalization when diving, it is important that the diving suit hood not make an airtight seal over the outside ear hole, and that earplugs not be worn. [2] Diving is proscribed when a eustachian tube is congested or blocked, such as can occur with the common cold, as this may cause what is known as a reverse block, whereby descent is uninhibited as the Valsalva maneuver may still clear the eustachian tubes temporarily by force, but during ascent a blockage may stop the air in the middle ear (which is now at depth pressure) from escaping as the diver ascends. The eardrum then bursts outwards, causing the same hazards as with an ordinary burst eardrum, such as cold water in the middle ear deranging the working of the sense organs of balance in the inner ear. [14]
Nasal congestion may affect the sinus openings and the eustachian tubes and may lead to difficulty or inability to clear the ears. To prevent congestion, allergies can be treated by the use of antihistamines, decongestants and nasal sprays, and allergy desensitization. Recently developed antihistamines do not cross the blood–brain barrier and do not produce drowsiness. [15]
Decongestants can have side effects such as speeding up heart rate which may have adverse effects in cases where there is underlying cardiovascular disease. Over-the-counter nasal sprays can produce a rebound effect causing greater congestion when the effect wears off, which can lead to reversed ear blockage on ascent. Some steroid nasal sprays do not have this side effect and can be very effective, but may also only be available by prescription.[ dead link ]
Combinations of the same drugs are useful in non-allergic rhinitis. These medications can be very useful in controlling the nasal congestion problem. [15]
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Divers get training in clearing the ears before being allowed to dive. [2] Because of the potential for side effects of the valsalva maneuver, scuba divers and free-divers may train to exercise the muscles that open the Eustachian tubes in a gentler manner. The French underwater association (Fédération Française d'Études et de Sports Sous-Marins) has produced a series of exercises using the tongue and soft palate to assist a diver in clearing their ears by these techniques. These recommendations were based on work done at the Médecine du sport, Bd st Marcel, Paris. [16] [17]
With practice it is possible for some people to close the nostrils hands-free by contracting the compressor naris muscles. Some people are able to voluntarily hold their Eustachian tubes open continuously for a period of several seconds to minutes. The 'clicking your ears' can actually be heard if one puts one's ear to another person's ear for them to hear the clicking sound. Those that are borderline on learning this voluntary control first discover this via yawning or swallowing or other means; which after practice can be done deliberately without force even when there are no pressure issues involved. When the Eustachian tubes are deliberately held open, one's voice sounds louder in one's head than when they are closed.
The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea.
In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air to the ossicles inside the middle ear, and thence to the oval window in the fluid-filled cochlea. The ear thereby converts and amplifies vibration in the air to vibration in cochlear fluid. The malleus bone bridges the gap between the eardrum and the other ossicles.
The Eustachian tube, also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately 35 mm (1.4 in) long and 3 mm (0.12 in) in diameter. It is named after the sixteenth-century Italian anatomist Bartolomeo Eustachi.
The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to clear the ears and sinuses when ambient pressure changes, as in scuba diving, hyperbaric oxygen therapy, or air travel.
Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with, the body and the surrounding gas or liquid. The initial damage is usually due to over-stretching the tissues in tension or shear, either directly by an expansion of the gas in the closed space or by pressure difference hydrostatically transmitted through the tissue. Tissue rupture may be complicated by the introduction of gas into the local tissue or circulation through the initial trauma site, which can cause blockage of circulation at distant sites or interfere with the normal function of an organ by its presence. The term is usually applied when the gas volume involved already exists prior to decompression. Barotrama can occur during both compression and decompression events.
A diving mask is an item of diving equipment that allows underwater divers, including scuba divers, free-divers, and snorkelers, to see clearly underwater. Surface supplied divers usually use a full face mask or diving helmet, but in some systems the half mask may be used. When the human eye is in direct contact with water as opposed to air, its normal environment, light entering the eye is refracted by a different angle and the eye is unable to focus the light on the retina. By providing an air space in front of the eyes, the eye is able to focus nearly normally. The shape of the air space in the mask slightly affects the ability to focus. Corrective lenses can be fitted to the inside surface of the viewport or contact lenses may be worn inside the mask to allow normal vision for people with focusing defects.
Dysbarism refers to medical conditions resulting from changes in ambient pressure. Various activities are associated with pressure changes. Underwater diving is the most frequently cited example, but pressure changes also affect people who work in other pressurized environments, and people who move between different altitudes.
Antonio Maria Valsalva, was an Italian anatomist born in Imola. His research focused on the anatomy of the ears. He coined the term Eustachian tube and he described the aortic sinuses of Valsalva in his writings, published posthumously in 1740. His name is associated with the Valsalva antrum of the ear and the Valsalva maneuver, which is used as a test of circulatory function. Anatomical structures bearing his name are Valsalva’s muscle and taeniae Valsalvae. He observed that when weakness of one side of the body is caused by a lesion in the brain, the culprit lesion tends to be on the side opposite (contralateral) to the weak side; this finding is named the "Valsalva doctrine" in his honor.
Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). If a conductive hearing loss occurs in conjunction with a sensorineural hearing loss, it is referred to as a mixed hearing loss. Depending upon the severity and nature of the conductive loss, this type of hearing impairment can often be treated with surgical intervention or pharmaceuticals to partially or, in some cases, fully restore hearing acuity to within normal range. However, cases of permanent or chronic conductive hearing loss may require other treatment modalities such as hearing aid devices to improve detection of sound and speech perception.
Aerosinusitis, also called barosinusitis, sinus squeeze or sinus barotrauma is a painful inflammation and sometimes bleeding of the membrane of the paranasal sinus cavities, normally the frontal sinus. It is caused by a difference in air pressures inside and outside the cavities.
The tensor veli palatini muscle is a thin, triangular muscle of the head that tenses the soft palate and opens the Eustachian tube to equalise pressure in the middle ear.
A perforated eardrum is a prick in the eardrum. It can be caused by infection, trauma, overpressure, inappropriate ear clearing, and changes in middle ear pressure. An otoscope can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally or require surgery.
In aviation and underwater diving, alternobaric vertigo is dizziness resulting from unequal pressures being exerted between the ears due to one Eustachian tube being less patent than the other.
A labyrinthine fistula is an abnormal opening in the inner ear. This can result in leakage of the perilymph into the middle ear. This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the air-filled middle ear. This is caused by a rupture of the round window or oval window ligaments separating the inner and middle ear.
The Frenzel Maneuver is named after Hermann Frenzel. The maneuver was developed in 1938 and originally was taught to dive bomber pilots during World War II. The maneuver is used to equalize pressure in the middle ear. Today, the maneuver is also performed by scuba divers, free divers and by passengers on aircraft as they descend.
Hypernasal speech is a disorder that causes abnormal resonance in a human's voice due to increased airflow through the nose during speech. It is caused by an open nasal cavity resulting from an incomplete closure of the soft palate and/or velopharyngeal sphincter. In normal speech, nasality is referred to as nasalization and is a linguistic category that can apply to vowels or consonants in a specific language. The primary underlying physical variable determining the degree of nasality in normal speech is the opening and closing of a velopharyngeal passage way between the oral vocal tract and the nasal vocal tract. In the normal vocal tract anatomy, this opening is controlled by lowering and raising the velum or soft palate, to open or close, respectively, the velopharyngeal passageway.
Tympanic membrane retraction describes a condition in which a part of the eardrum lies deeper within the ear than its normal position.
Scuba skills are skills required to dive safely using self-contained underwater breathing apparatus, known as a scuba set. Most of these skills are relevant to both open-circuit scuba and rebreather scuba, and many also apply to surface-supplied diving. Some scuba skills, which are critical to divers' safety, may require more practice than standard recreational training provides to achieve reliable competence.
Eustachian tube dysfunction (ETD) is a disorder where pressure abnormalities in the middle ear result in symptoms.
Middle ear barotrauma (MEBT), also known to underwater divers as ear squeeze and reverse ear squeeze, is an injury caused by a difference in pressure between the external ear canal and the middle ear. It is common in underwater divers and usually occurs when the diver does not equalise sufficiently during descent or, less commonly, on ascent. Failure to equalise may be due to inexperience or eustachian tube dysfunction, which can have many possible causes. Unequalised ambient pressure increase during descent causes a pressure imbalance between the middle ear air space and the external auditory canal over the eardrum, referred to by divers as ear squeeze, causing inward stretching, serous effusion and haemorrhage, and eventual rupture. During ascent internal over-pressure is normally passively released through the eustachian tube, but if this does not happen the volume expansion of middle ear gas will cause outward bulging, stretching and eventual rupture of the eardrum known to divers as reverse ear squeeze. This damage causes local pain and hearing loss. Tympanic rupture during a dive can allow water into the middle ear, which can cause severe vertigo from caloric stimulation. This may cause nausea and vomiting underwater, which has a high risk of aspiration of vomit or water, with possibly fatal consequences.