The middle ear is an air-filled cavity located behind the eardrum, which lacks the ability to self-regulate pressure. The eardrum itself is a thin membrane that separates the outer ear from the middle ear.

Doctor Nguyen Duc Ngoc, a senior specialist at the Ear, Nose, and Throat Center, Tam Anh General Hospital TP HCM, explains that during scuba diving, if middle ear pressure is not equalized promptly, the stronger external pressure pushes inward, causing the eardrum to stretch excessively and easily rupture or perforate. The deeper one dives, the greater the surrounding pressure on the body.

Symptoms of eardrum perforation often include pain, ringing in the ears, earache, hearing loss, or discharge and bleeding from the ear. If water enters through the perforation, it can lead to middle ear infection and acute vertigo due to irritation of the vestibular system. Untreated, this condition can cause chronic middle ear infection with perforation or mastoiditis.

Doctor Ngoc performing an ear endoscopy on a patient. *Photo: Tam Anh General Hospital*

A doctor uses an endoscope to assess the perforation, prescribes medication, and supports the healing process of the eardrum. Small perforations can heal on their own with careful management following medical advice or internal medicine treatment. Patients must keep their ears dry, prevent water from entering, avoid swimming or sea bathing during this period, and limit contact with individuals suffering from respiratory infections.

If the eardrum does not heal naturally, or if perforation is accompanied by a middle ear infection, doctors will stabilize the infection before recommending endoscopic eardrum repair surgery.

Doctor Ngoc advises divers to prevent barotrauma by gradually descending, avoiding sudden changes, to maintain pressure balance between the middle ear and the external environment.

During a dive, actively equalize pressure using the Valsalva maneuver: pinch your nose, close your mouth, and gently breathe out through your nose to introduce air into the middle ear. If you experience ear pain, stop or ascend slightly to equalize pressure. Individuals with colds, stuffy noses, sinusitis, or ear infections should avoid scuba diving, as these conditions can block the Eustachian tube, making pressure equalization difficult and significantly increasing the risk of eardrum perforation.

If gentle pressure equalization does not alleviate ear pain, ringing in the ears, or fullness, stop diving. A "pop" sound in the ear indicates an eardrum perforation, requiring immediate cessation of diving. After scuba diving, if you experience ear pain, ringing in the ears, hearing loss, or ear discharge, seek prompt examination, assessment, and treatment from an ENT specialist.

Uyen Trinh