This article summarizes current pediatric and specialty guidance. Every child’s age, history, injury, and procedure are different. Seek urgent in-person care for red-flag symptoms rather than relying on an online article.
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Immediate actions
Stop diving, protect the diver from falls and aspiration, provide the highest available concentration of first-aid oxygen when trained equipment is present, and contact emergency services, a diving medicine physician, or DAN.
Do not re-enter the water to “push bubbles back in.” DAN advises that symptomatic divers should generally be removed from the water and treated on the surface. In-water recompression carries risks of loss of consciousness, oxygen toxicity, hypothermia, vomiting, and inadequate gas supply.
Symptoms of inner-ear decompression sickness
Possible symptoms include sudden spinning vertigo, tinnitus, hearing loss, nausea, vomiting, nystagmus, gait instability, and imbalance. Other decompression illness signs may include numbness, weakness, visual change, headache, confusion, mottled skin, or joint pain.
Symptoms may begin during ascent or hours later. Staying within computer limits does not eliminate decompression sickness risk.
How inner-ear barotrauma overlaps
Inner-ear barotrauma may follow difficult equalization, forceful Valsalva, ear pain, or fullness and can also cause vertigo, tinnitus, and hearing loss. The external ear examination may be normal despite inner-ear injury.
The conditions overlap clinically but may require different management. Do not rely on ear pain alone or attempt a boat-side diagnosis.
When to call an ambulance
Severe vertigo, repeated vomiting, inability to stand, weakness, slurred speech, facial droop, confusion, seizure, chest pain, breathing difficulty, coughing blood, loss of consciousness, or rapid progression requires emergency activation.
Improvement with oxygen does not rule out decompression illness. Symptoms can recur and oxygen is not a substitute for medical evaluation.
Care while awaiting help
Maintain airway and breathing, use the recovery position for vomiting or reduced consciousness, and prevent falls. Small amounts of nonalcoholic fluid may be given only to a fully alert diver who can swallow safely.
Record depth, time, gas, ascent, stops, repetitive dives, symptom onset, and progression, and bring the dive computer. Multiple affected divers may suggest contaminated breathing gas.
Flying and transport
Do not take a commercial flight or travel to higher altitude with suspected decompression illness. Transport should be coordinated with emergency and diving medicine services.
Treatment requires a medically appropriate chamber and team, not simply any facility marketed as hyperbaric therapy.
Is delayed recompression useless?
Earlier treatment is preferred, but a delay does not automatically eliminate benefit. Contact a diving medicine service even after hours have passed.
Assessment may include neurologic, ear, vestibular, and hearing evaluation. Rehabilitation and follow-up may be required.
Return to diving
Do not dive again until diagnosis is clarified and symptoms have fully resolved. Return timing depends on neurologic, hearing, vestibular recovery, treatment, and risk factors and should be determined by a diving medicine physician.
The safe default for post-dive dizziness or tinnitus is surface oxygen, urgent expert evaluation, no altitude, and no return to water.
Frequently asked questions
Can I go home if oxygen stops the dizziness?
No. Symptoms can temporarily improve and recur; medical assessment remains necessary.
Can I go back underwater for a safety stop?
No. Symptomatic divers should generally remain out of the water and receive surface care.
Does ear pain prove barotrauma instead of DCS?
No. Symptoms overlap and expert evaluation is required.
Can DCS happen within computer limits?
Yes. A dive computer reduces but does not eliminate risk.
Should I seek help after 24 hours?
Yes. Delay does not mean evaluation or treatment is useless.
References
- Divers Alert Network: Ear injuries
- Divers Alert Network: In-water recompression
- Divers Alert Network: Treating decompression sickness
Original educational content based on publicly available professional guidance. It does not replace clinical examination.
Pediatric surgery, trauma surgery, hyperbaric and diving medicine. Last updated: July 24, 2026.