DAN guide explains six ear equalization methods for scuba divers

Nearly 50 percent of DAN Emergency Hotline calls are ear problems, and the most common injury is middle-ear barotrauma, or MEBT. If your ears start fighting you on descent, the fix is not to push harder. Equalize early, keep doing it often, and stop the moment it turns into pain.

Why this is a timing problem, not a toughness test

Equalization works by opening the lower ends of the Eustachian tubes so air can enter the middle ear and keep pressure balanced. Pressure changes begin affecting the ears almost immediately on descent, long before a diver feels truly “deep.” Ear injuries are the leading cause of morbidity among scuba divers, and various surveys put the share of divers who experience MEBT at some point at more than 50 percent.

That injury is often quieter than divers expect. Most cases of MEBT are mild, heal spontaneously, and are never reported. The same pressure injury can also happen while flying.

DAN’s Health & Diving Reference Series draws on years of DAN-supported research and on assisting thousands of members through dive and medical emergencies. Equalization is not a single trick you learn once; it is a family of techniques you choose from depending on how your body, your mask, and the descent are behaving.

Start with the method that fits the failure mode

Valsalva, for the diver who needs the simplest baseline

Valsalva is the one most of us learn first. Pinch your nostrils, or close them against the mask skirt, and gently blow through your nose so the overpressure in your throat pushes air up the Eustachian tubes. It is a good starting point when you are early in the descent and the ears just need a small pressure nudge.

The trap is turning a gentle tool into a force contest. If Valsalva needs repeated hard blows, you are no longer equalizing, you are wrestling your ears, and that is the moment to back off. A clean Valsalva should feel like a brief release, not a strain in the face, jaw, or chest.

Toynbee, when swallowing works better than blowing

Toynbee is the answer when your throat and swallow reflex seem more cooperative than pressure from the nose. The method pairs a pinch of the nose with a swallow, which can open the tubes without asking you to generate much force. For some divers, that makes it the better option when the ears feel sticky but not yet painful.

Use it as a quieter reset, not a rescue from pain. If swallowing once or twice does nothing, do not keep descending and hoping the next swallow fixes it on its own. That is the point to stop the drop, ascend a little, and try again with less pressure on the ear.

Frenzel, when you need control without brute force

Frenzel belongs in the toolbox for divers who want finer control than a hard exhale can offer. Different bodies respond to different mechanics, and some divers do better with a technique that relies less on overall pressure and more on deliberate control. In practice, it is often the method to reach for when you want a more precise, less forceful clear.

Think of Frenzel as a control move, not a muscle move. If you can feel the need to strain, you are drifting toward the same mistake that makes Valsalva fail, which is trying to overpower a blockage instead of opening the tubes cleanly. If the ears still resist after a calm attempt, do not keep forcing the issue.

Lowry, when a combination beats a single move

Lowry is useful when one method alone feels incomplete. Some divers need a hybrid approach. Lowry combines elements that can help the ears open when a single gentle blow or swallow is not enough.

This is the method for the diver who says, “That nearly worked.” Nearly worked is your cue to slow down, not to double down. Try the combination early, while the pressure is still manageable, and abandon it if your ears are already complaining.

Edmonds, when jaw position helps the tubes open

Edmonds brings jaw movement into the equation. For divers whose ears respond to movement in the face and throat, that extra coordination can make the difference between a stubborn clear and a clean one. Equalization is not only about pushing air, it is also about opening the pathway that lets the air move.

If your jaw feels locked or your face is tense, that is not the moment to try harder. Ease off, relax the jaw, and reset before the pressure stacks further. A technique that depends on fine coordination usually fails once you have already crossed into discomfort.

BTV, when you can voluntarily open the tubes

BTV, or voluntary tubal opening, is the most elegant option when it works. Instead of forcing air up, you consciously open the Eustachian tubes themselves. All six methods are simply ways to let air into the middle ear. For divers who can do it, BTV is often the least forceful and most repeatable choice on a long, gradual descent.

It is also the least useful method to discover for the first time when you are already in trouble. Practice matters here, because a voluntary technique has to be available before the squeeze starts. If it is not automatic yet, keep it as a future skill and rely on the methods you can execute calmly today.

The red flags that mean pause, rise, or abort

Pain is not a cue to keep descending. MEBT can range from mild discomfort to a ruptured eardrum, and a 2020 review in the Australian Journal of General Practice by Lyndon Nofz, Jemma Porrett, Nathan Yii, and Nadine De Alwis found that scuba diving-related otological injuries make up the majority of diving-related incidents seen by general practitioners, with correct diagnosis and management key to preventing permanent hearing loss and vertigo.

When equalization starts slipping, act on the first warning, not the third.

• Pause if a clear takes more than a gentle effort or two.
• Ascend slightly if one ear stays blocked while the other clears.
• Abort the descent if you feel sharp pain, increasing pressure, or a need to blow harder each time.
• Never keep going deeper hoping the next few feet will “work it out.”
• Skip earplugs for scuba because they can have detrimental results.

The real fix is earlier equalization, gentler technique, and the discipline to stop before pressure becomes injury.