As you change atmospheric pressure (increase or decrease) in a hyperbaric chamber, your ears will have to pressurize with those changes. i.e. your inner ear pressure needs to balance with your external ear pressure. It's kind of like the feeling you get when in an airplane or on a train that is going under water. 

Although it is rare to have issues, it is important to be able to clear your ears to prevent discomfort and potential damage. It's important to remember that HBOT should never be painful! 

Before we get into the tricks of the trade, here are some considerations before you dive: 

Considerations Prior to Diving 

1. Ear wax: if you have ear wax that completely occludes your eardrum, it will be very difficult to equalize pressure. Considering seeing an ENT or PCP that can clear your ears out. You'll also be amazed at how well you can hear after this is done by the way! 
2. Nasal congestion:  If you have nasal or sinus congestion, there will be more fluid in your inner ear making it more difficult to equalize pressure.  If you've ever been on an airplane and had a cold, you know exactly what we mean. If at all possible, do not dive with nasal congestion but if you have allergies, consider nasal steroids or antihistamines to help clear your nasal passages prior to your dive. 
3. Pre-existing ear conditions: Be aware that it may be more difficult to clear in the chamber. Take your time with pressurization and depressurization.
4. The deeper you go: Typically the deeper the dive, the more of a challenge pressurization may be. Remember, go slow when you first start. 
5. If you have a hard time on planes: HBOT may be difficult for you. See maneuvers below and the ear planes, especially, and keep it slow with pressurization and depressurization. 

Okay, now that's out of the way, here are some easy tips and tricks to make your hyperbaric experience a smooth ride (and dive). 

1. Valsalva Maneuver

The Valsalva maneuver is a widely used technique to equalize the pressure in your ears. To perform this maneuver, pinch your nose shut and gently blow air out through your nose. This helps to open the Eustachian tubes and equalize the pressure. 

2. Swallowing

Swallowing can also help to equalize the pressure in your ears. When you swallow, the muscles in your throat open the Eustachian tubes, allowing air to flow in and out of your middle ear. You can try swallowing saliva or taking a sip of water to facilitate this process. 

3. Toynbee Maneuver

The Toynbee maneuver is another technique that can be used to clear your ears. To perform this maneuver, pinch your nose shut and swallow at the same time. This combination of actions helps to open the Eustachian tubes and equalize the pressure.

4. Yawning

Yawning is a natural reflex that can also help to equalize the pressure in your ears. When you yawn, the muscles in your throat and jaw stretch, which can open the Eustachian tubes and allow air to flow in and out of your middle ear. The same effect is possible when chewing gum but this may not be allowed in most (if not all) hyperbaric chambers! 

5. Frenzel Maneuver

The Frenzel maneuver is a technique commonly used by scuba divers to equalize their ears. To perform this maneuver, close your nostrils with your fingers and make a "k" sound while keeping your mouth closed. This action helps to contract the muscles in the back of your throat, opening the Eustachian tubes.

6. Descending and Ascending Slowly

When diving in a hyperbaric chamber, you have control of your rate of descending and ascending. Rapid changes in pressure can make it more difficult to equalize your ears. By taking your time and allowing your body to adjust to the pressure changes gradually, you can minimize the risk of ear discomfort.

7. Ear planes

If the above aren't successful, ear planes are a specialized type of ear plugs that may do the trick. You can check them out here.   

Troubleshooting

If, despite the techniques above, you are still having a hard time pressurizing in a hyperbaric chamber, please consider seeing your primary care or an Ear, Notes, and Throat provider to have an examination. 

Conclusion

Clearing your ears when diving in a hyperbaric chamber is essential for a comfortable and safe experience. The techniques mentioned above, such as the Valsalva maneuver, swallowing, Toynbee maneuver, yawning, Frenzel maneuver, and descending/ascending slowly, can help you equalize the pressure in your ears effectively. Remember to consider your ears pre-dive (congested today? can I hear my wife?) and that HBOT should never be painful. For any questions or concerns, see your PCP or ENT to get them checked out!