Ear Problems and Infections for Divers on Koh Tao

Why do ears hurt after diving ?

Because the middle ear is an air space, and air spaces obey pressure. On descent the water pressure rises and pushes inward on the eardrum, and unless you equalise — pushing air up the Eustachian tube to match — the eardrum is squeezed. That squeeze is barotrauma, and it ranges from mild discomfort and redness to bleeding behind the drum or, at the extreme, a perforation.

The outer ear has a different problem. Warm seawater sitting in the ear canal for hours a day, several days running, strips the canal's protective wax and creates ideal conditions for bacteria. That is otitis externa, commonly called swimmer's ear, and on a dive island it is close to an occupational hazard.

Both hurt. They need different treatment, which is the practical reason to be examined rather than to guess or to borrow someone's leftover drops.

How do you tell the difference ?

This table helps you understand what is happening. It does not replace an examination, because the two can coexist, and because a perforation changes the treatment entirely — several standard ear drops must not be used if the eardrum is not intact.

When must you stop diving ?

Immediately, in every one of these situations. There is no version of this where continuing is the sensible call.

• you cannot equalise on descent, on either ear
• you have ear pain during or after a dive
• your hearing is muffled or you have ringing
• there is any discharge or bleeding from the ear
• you feel dizzy or unsteady during or after a dive
• you have a cold, blocked nose or sinus congestion

What does treatment on Koh Tao involve ?

An examination with a digital otoscope first, which lets the doctor see the eardrum and the canal directly and tell you exactly what is going on. Treatment then follows the diagnosis: ear care for an infection generally means cleaning the canal and appropriate drops, while barotrauma is usually managed with decongestion, time and a diving pause rather than antibiotics.

Earwax, and why it matters here

Impacted wax is the third common presentation, and it is disproportionately a dive-island problem. Wax that sits harmlessly at home becomes a genuine obstacle when you need to equalise several times a day, and it also traps water against the canal wall. Removal by ear irrigation is a routine procedure at our Koh Tao clinic, and divers often find equalising becomes dramatically easier afterwards.

How long will you be out of the water ?

That depends on what is found, and an honest examination gives an honest answer rather than an optimistic one. Mild barotrauma is usually the shortest pause. An infection means a course of treatment and no diving until the canal has settled. A perforation is the longest, and it is the outcome most often produced by forcing a descent that was not working. The doctor gives you a specific interval once the ear has been looked at, rather than a number guessed from this page.

Sinus problems get missed for the same reason

The sinuses are air spaces too, and they squeeze under pressure exactly as the middle ear does. Sinus barotrauma presents as pain across the forehead, cheeks or upper teeth during descent or ascent, sometimes with a small amount of blood in the mask. Divers frequently attribute it to a headache or to the mask itself and carry on.

The prevention is identical to the ear advice and the reason is the same: congestion blocks the passage that equalises the space. Diving on decongestants to get through a blocked nose is a poor strategy, because the medication can wear off at depth and leave you unable to equalise on the way up.

Do ear plugs and drops help ?

Purpose-made vented dive plugs exist and some divers find them useful, but ordinary swimming plugs must never be worn diving — they trap an air space in the ear canal that cannot be equalised, which produces exactly the injury you were trying to avoid. If you want to use plugs, ask about the vented type specifically.

Drying drops used after diving can help prevent outer-ear infection by shifting the moisture that bacteria need. They are a preventive measure rather than a treatment, and they should not be used on an ear that is already painful or discharging, or where the eardrum may not be intact. Ask before starting them rather than after.

How do you prevent it ?

1. Equalise early and often, starting at the surface and continuing every metre or so on descent.
2. Descend feet-first and slowly, using a line where one is available.
3. Never force it. If an ear will not clear, ascend slightly and try again; if it still will not, end the dive.
4. Rinse ears with clean fresh water after diving and dry them gently.
5. Do not dive with a cold or congestion, however good the conditions are.
6. Do not put cotton buds in your ears, which pushes wax inward and scratches the canal.

Divers wanting more background will find Divers Alert Network the standard reference on ear and sinus barotrauma, and the NHS page on ear infections a sound plain-English summary.

Should you be seen ?

• Ear pain that started on a dive → same day, and stop diving now
• Itching, then pain, over a day or two → same day; this pattern is usually infection
• Discharge, bleeding or sudden hearing loss → immediately
• Dizziness during or after a dive → immediately; this can be serious
• Cannot equalise, no pain → be seen before your next dive, not after
• Mid-course with a blocked ear → be seen today; two more days makes it worse

The wider scope of what our Koh Tao clinic treats covers everything else, and a blocked ear on the day of your dive medical is worth declaring rather than hoping goes unnoticed.