Stoppering the Problem: Do Ear Plugs Work Underwater?

The question of divers using vented ear plugs to ease equalization and keep water out of their ears is often raised on divers’ online message boards. These soft polymer plugs form a tight seal and have a very small hole, or vent, running through them to allow for equalization of the ear. Many responders indicate that the plugs reduce the frequency of external ear canal infections and ease clearing of the ears.

Doc’s Proplugs (www.proplugs.com) is the primary purveyor of vented ear plugs. It claims that when fitted properly, the plugs reduce “ear squeeze caused by inability to equalize between the outer and middle ear,” and help “prevent outer ear and inner ear infection, vertigo and thermal reaction. ” Its Web site includes a list of undated and unverifiable testimonials.

Only minimal medical research has been conducted on these ear plugs. A self-published, undated piece by the Sardinian Institute of Underwater and Hyperbaric Medicine evaluated two professional divers with histories of perforated eardrums “who in the summer made constantly 3 dives per day.” After observing one diver for 17 months and the other for three months, no problems with inflammation of the middle ear were noted. Another study found that in patients involved in various watersports, the use of earplugs substantially reduced surfer’s ear/exostosis (benign bony growth in the external ear canal caused by exposure to cold, wet and windy conditions).

If a vented ear plug did lessen the flow of water into the external auditory canal, the expectation is that outer ear infections (swimmer’s ear) would be reduced. As for preventing inner ear infections, this isn’t believable. Water does not enter the middle ear space from the outer ear unless the eardrum is ruptured. And someone with a perforated eardrum should not be diving anyway. Decreased water flow also would be expected to reduce temperature-related abnormalities, such as vertigo and surfer’s ear.

The claim of easing equalization is difficult to support, as there is no reasonable mechanism to explain how this might occur. Doc’s Proplugs’ Web site states, “Due to surface tension, the vented plug also reduces abrupt pressure changes from reaching the sensitive eardrum which contributes to easier equalization.” I find this assertion neither comprehensible nor compelling.

I was unable to find any published reports of harm to the ear from such plugs. Provided the vent in the plug remains unobstructed, these devices appear to pose little or no danger to the ear. However, if a vent should become clogged, especially upon descent, equalization could become impeded and the eardrum damaged. Using such plugs to protect a ruptured eardrum may give a diver a false sense of security. He runs the risk of losing the device during a dive, allowing water to enter the middle ear space and resulting in pain, disorienting vertigo and possible infection.

The bottom line? If you’re experiencing external ear infections or worried about surfer’s ear, vented plugs may be worth the small investment. However, divers with middle-ear congestion or infection are unlikely to benefit from these plugs, and they should refrain from diving until seen by an ear, nose and throat specialist. For those with continuing difficulty in equalizing, experiment with various clearing techniques before resorting to these vented ear plugs stoppers.

— Doc Vikingo