![[Diving Safety] Headache After Diving? Nosebleed After Diving? Ear Pain After Diving? 8 Physical Symptoms That May Occur During a Dive](/_images/8979b966ff5d-1440w.webp)
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The Editor says: Scuba diving is an extremely safe water activity. As long as you follow the guidelines and SOPs of your certification agency, you can glide through the ocean and enjoy the breathtaking scenery beneath the surface. However, the underwater environment is fundamentally different from life on land, and the physiological changes triggered by shifts in the physical laws of nature can cause discomfort during a dive — and in some cases, genuine risk. Let's take a look at what Dr. Tsai Kai-Yu, ENT & Head and Neck Surgery Specialist has to share about common causes of physical discomfort in diving and how to address them!
More and more friends have recently been asking Dr. Tsai Kai-Yu about physical discomfort experienced after diving, as well as general diving precautions. Dr. Tsai has compiled the most frequently asked questions from the diving community here, along with possible explanations for reference.
What Are the 3 Types of Diving?
For those unfamiliar with diving, it actually encompasses 3 common forms:
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Snorkeling
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Scuba diving (with a tank)
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Freediving (without a tank)
Before Reading On, Here Are a Few Physical Principles You Should Know:
1. Changes in Water Pressure
As a general rule, pressure increases by one atmosphere for every 10 metres of depth — a fairly rapid change in pressure.
2. Boyle's Law
At a constant temperature, the volume of a gas is inversely proportional to the pressure applied to it. This means that the air-filled cavities in the body are prone to barotrauma during descent. Which cavities does the body have? They include the middle ear, inner ear, sinuses, periodontal spaces, the larynx and trachea, the lungs, and the gastrointestinal tract.
3. Henry's Law
The solubility of a gas in a liquid is directly proportional to the partial pressure of that gas. This means that for scuba divers, the deeper you go, the more gases dissolve into your body — including oxygen, nitrogen, and helium. This can lead to oxygen toxicity, nitrogen narcosis, and decompression sickness (DCS) if an appropriate decompression stop is not made during ascent.
Common Questions and Answers
Ear Pain After Diving:
This is probably the most common issue encountered by beginners, and even experienced divers can occasionally run into it. The cavity behind the eardrum is called the middle ear, and its pressure is regulated through the Eustachian tube, which opens from the nasopharynx at the back of the nasal cavity. Conditions such as chronic nasal allergies, a deviated nasal septum, colds, sinusitis, nasal polyps, or adenoid hypertrophy in the nasopharynx can all impair Eustachian tube function. During descent, as water pressure increases, the inability to effectively open the Eustachian tube and allow air to enter the middle ear for equalization can result in middle ear barotrauma.
Middle ear barotrauma can range in severity from mild eardrum redness and swelling to middle ear effusion, bleeding, otitis media, and even eardrum rupture. This can also occur due to poor equalization technique — for example, using the Valsalva maneuver (common in scuba diving) or the Frenzel Maneuver (common in freediving) incorrectly. If you experience middle ear barotrauma or difficulty equalizing, it is advisable to see an ENT specialist for an endoscopic evaluation of the nasal cavity and Eustachian tube, along with a tympanometry test to assess the severity.
Unlike middle ear barotrauma, the more serious inner ear barotrauma can cause hearing loss, tinnitus, and dizziness — this is a medical emergency and must be addressed by an ENT specialist as quickly as possible. A similar condition is inner ear decompression sickness (DCS); the two have very different treatments and must be distinguished by an experienced physician.
Nosebleed After Diving:
This is also a very common issue. Some instructors tell students it's caused by pinching the nose too hard — but that's not usually the case, unless the mucosa at the front of the nasal septum is particularly fragile or the blood vessels are especially prominent. In most cases, nosebleeds are caused either by sinus barotrauma or by blood from a middle ear barotrauma that drains from the ear through the Eustachian tube and into the nasal cavity.
Headache After Diving:
There are several common causes:
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Headache from sinus barotrauma, which varies by location — for example, frontal sinus pain presents at the forehead, maxillary sinus pain in the cheeks, ethmoid sinus pain around the eye socket, and sphenoid sinus pain at the back of the head.
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Tension headache: a muscle-related pain, commonly caused by excessive tension in the water or from clenching the regulator mouthpiece too hard.
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Elevated carbon dioxide levels in the blood, which cause dilation of cerebral blood vessels and trigger a headache similar to a migraine.
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Headache caused by decompression sickness (DCS), which is typically accompanied by other DCS symptoms.
Dizziness After Diving:
Common causes include the caloric response caused by cold water entering the ear canal, pressure imbalance between the two ears, inner ear barotrauma or perilymphatic fistula, oxygen toxicity (which can occur with pure oxygen at pressures above 1.5–2 atmospheres), and nitrogen narcosis (at 30 metres underwater, nitrogen narcosis is equivalent to the effect of one martini, with the effect of an additional martini for every extra 10 metres).
Coughing Up Blood After Diving:
Possible causes include laryngeal and tracheal barotrauma, or pulmonary barotrauma resulting in hemothorax. It is recommended to seek evaluation from both an ENT specialist and a pulmonologist.
Chest Pain and Difficulty Breathing After Diving:
This is typically caused by pulmonary barotrauma leading to pneumothorax, or alveolar rupture resulting in hemothorax. This is a medical emergency and requires immediate treatment in an emergency department.
Decompression Sickness:
According to Henry's Law, when the pressure of a gas above a liquid decreases, the amount of that gas dissolved in the liquid also decreases. Nitrogen is a gas dissolved in human tissues and bodily fluids. When the body is exposed to a drop in ambient pressure, nitrogen is released from the blood into the tissues. If nitrogen is forced out of the body fluids too quickly, bubbles form within the body, causing symptoms of decompression sickness — including skin itching and rashes, joint pain, sensory organ impairment, paralysis, and even death. It is therefore essential to observe proper decompression stops and to avoid flying on the day of diving (as doing so is essentially a second decompression). Treatment involves recompression in a hyperbaric chamber and inhalation of pure oxygen — known as hyperbaric oxygen therapy.
Shallow Water Blackout:
This occurs during freediving. During descent, the increasing partial pressure of oxygen causes the body to unknowingly consume oxygen at a higher rate. Then, during a rapid ascent, the partial pressure of oxygen drops suddenly, causing temporary cerebral hypoxia and a brief loss of consciousness — a phenomenon known as a blackout.
Dr. Tsai Kai-Yu ENT & Head and Neck Surgery Specialist Hyperbaric and Undersea Medicine Specialist
Cover image credit: Image by David Mark from Pixabay
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