Scuba Diving And Reverse Block (According To A Scuba Instructor)

You’ve had a great day so far! Nice boat ride to your dive site, entry went well, no issues with descent and an excellent dive. Now on ascent, you begin to experience pain in your ear. You, my friend, have a reverse block. Read below to learn what that is, how it happens and what to do if it occurs.

Photo of scuba divers on ascent. — A reverse block can occur on ascent and can cause pain in your ear, face and/or forehead.

Cause

Middle Ear Reverse Block

As set forth here, middle ear squeeze occurs on descent when the water pressure pushes on our eardrum (tympanic membrane), reducing the space in our middle ear (tympanic cavity). Once the dive is done and you begin to ascend, the pressure is now lessening. As this occurs, the air in the middle ear, according to Boyle’s Law, is starting to expand and hopefully escape.

The air escaping your middle ear on ascent generally happens automatically and typically may not be an issue of concern. However, if you dive with congestion from sinus issues, known or unknown, the air in the middle ear may get trapped, pushing the eardrum out into the ear canal.

Sinus Reverse Block

We have four sets of sinus in our face and forehead. Normally, the sinuses equalize on their own with no issues. However, If you dive while having symptoms from a cold or allergies, there may be inflammation of the mucous membranes in the sinus cavities. This inflammation can reduce, or block, the narrow passages through which air escapes the sinus cavities on ascent.

Diagram of sinus cavities. — The four sets of sinuses generally equalize automatically.

Injuries/Symptoms

Middle Ear Injury/Symptoms

If you have a middle ear reverse block, you may experience vertigo and/or feel pain in your ear. If you push through middle ear reverse block pain and continue to ascend, you can end up with a ruptured ear drum and potentially permanent or temporary hearing loss. Other symptoms include ringing in the ear, a feeling of fullness in your ear and draining of clear of bloody fluid from your ear.

Picture of person feeling dizzy. — Vertigo is a common symptom of middle ear reverse block.

Sinus Injury/Symptoms

With sinus reverse block, you may actually not feel anything at all. If you do feel something, it may be pressure or pain in your face and/or forehead. You may also have a little bloody discharge from your nose and/or some post nasal drip.

Scuba diver with little blood in mask from sinus reverse block. — You may have a little bloody discharge in your mask, if experiencing a sinus reverse block. (photo courtesy of bestpub.com)

Actions for Relief

Middle Ear Relief

If on ascent you are experiencing pain in your middle ear, STOP! Slowly start to descend and, while descending, equalize with either the Valsalva maneuver or Frenzel method. This will hopefully open up the passage way so the air can now escape from your middle ear on ascent. Slowly begin to ascend. If you still can’t clear and are running out of bottom time, you will have to endure the pain and surface.

scuba diver pinching his nose and doing the Valsalva maneuver. — If experiencing a reverse block middle ear pain on ascent, stop and slowly descend and try to equalize using the valsalva maneuver, pictured above, or the Frenzel method. (Photo courtesy of Dresseldivers.com)

NOTE – You do not equalize on ascent like you would do to combat middle ear squeeze on descent. If you are having a reverse block and equalize on ascent, you are just adding more air to the middle ear and making the problem worse.

If you are experiencing vertigo due to middle ear reverse block, also stop your ascent if safe to do so. Descend a little to help your middle ear equalize. Then try to slowly ascend as your remaining air supply will allow. With vertigo, it also helps to focus or grab on to a fixed point on a stationary object, like an anchor or buoy line.

Photo of diver's hand on a buoy line underwater. — If you experience vertigo, try to grab or focus on a fixed position of a stationary object, like a buoy line.

Sinus Relief

Unfortunately, there is nothing you can do to help with a sinus reverse block. Either the sinus cavities will equalize, or they will not. Here, prevention (see below) is your best defense from getting a sinus reverse block.

Prevention

Best way to prevent a reverse block is to not dive while suffering from allergies or while you have a cold. When “congested” you may have issues with air moving as we want it to as divers with both equalizing on descent and then when coming up on ascent. With middle ear reverse block, equalizing early and often on descent will also help avoid a reverse block on ascent.

Photo of woman blowing her nose. — To avoid a reverse block, don’t dive while congested.

Medications

Some divers, including yours truly on occasion, have found the use of anti-inflammatory, anti-allergy and decongestant medications, such as pseudoephedrine, helpful in equalization. Before using such medication, make sure to consult with your Dr. to make sure it is right for you and is not contradictory to any other medicine you may be taking. I would also recommend trying any new medicine a couple of days prior to diving to see if you experience any side effects, prior to them occurring while you are under the water.

Picture of Sudafed in package. — Make sure to consult with your Dr. before using any medication, like Sudafed, while diving.

Wrapping things up

With reverse block, a good offense is definitely the best defense. Your affirmative actions of not diving while congested and equalizing early and often on descent will go a long way to help prevent a reverse block. If you are feeling a middle ear reverse block, stop ascending as long as you can safely do so. Descend a little, equalizing on descent. If the block still does not clear and your tank air supply is getting low, you may have to push through the pain and surface.

Photo of scuba diver equalizing underwater. — Equalizing early and often on descent will help to avoid a reverse block in your middle ear on ascent.

If you have a cold or are suffering from allergies, do not dive. Come back when feeling better. Missing a couple of days of diving is better than risking a permanent injury.

If You’re Looking For other Scuba Diving Tips, Check Out The Below.

“How boring would the world be if everywhere and everyone were the same. Safe travels and good adventures.” Scuba Jay

Scuba Diving And Reverse Block (According To A Scuba Instructor)