It is always a good idea to equalize before you enter the water. This helps open up the spaces and helps ensure you can, in fact, equalize. Do not force or blow too hard because it may cause damage. If you feel discomfort or pain on descent, follow these guidelines.
- Ascend about 1 meter/3 feet, and try equalizing again. Swallowing and wriggling the jaw can also help. Do not overdo it.
- If you continue to feel pain or discomfort, it is better to abort the dive. Make sure you let your buddy/dive guide/instructor know you are having issues by using the correct hand signal.
- If you need to abort the dive, ensure you follow correct ascent procedures. Do not rush, but follow a slow and controlled ascent.
- If pain persists or if you have a full feeling in your ears or sinuses, trouble hearing or dizziness, or blood in your mask after a dive, seek immediate medical advice. While most ear or sinus problems will be relatively minor and resolve themselves in a few weeks or so, seeking medical advice is very important to prevent further complications.
If a diver does not equalize early or often enough, the pressure differential can force the soft tissues together, closing the ends of the Eustachian tubes. Forcing air against these soft tissues just locks them shut. No air gets to the middle ears, which do not equalize, so a barotrauma results. Even worse, blowing too hard during a Valsalva maneuver can rupture the round and oval windows of the inner ear.