Ear Pressure and Claustrophobia in a Hyperbaric Chamber: A Practical Guide

Equalizing means letting air into your middle ear through the Eustachian tube, the small passage that connects your ear to the back of your throat. These are the techniques commonly used by divers, air travelers and hyperbaric patients. Start with the gentlest one. The team will explain how to equalize before your first session, so follow their instructions if they differ from what you read here.

1. Swallow or yawn

Swallowing and yawning both open the Eustachian tube naturally. For many people, this is all they need. Start swallowing as soon as pressure begins to rise.

2. Move your jaw

Wiggle your jaw side to side or push it gently forward, as if starting a yawn. Some people find a slight head tilt helps too.

3. Pinch your nose and swallow

Close your nostrils with your fingers and swallow. This is often called the Toynbee maneuver. It pulls gently on the Eustachian tube and helps it open.

4. Pinch your nose and blow gently

Close your nostrils, close your mouth, and blow very gently as if blowing your nose, until you feel your ears pop. This is the Valsalva maneuver. The key word is gently. Blowing hard can injure the ear, so never force it.

5. Equalize early and often

The most important technique is timing. Clear your ears before they feel blocked, and keep doing it every so often while pressure is rising. Once the Eustachian tube is squeezed shut by pressure, it is much harder to open. Practicing swallowing with your nose pinched at home can help you feel ready.

If any unfamiliar terms appear, our glossary explains equalization, barotrauma and more.

Congestion is the most common reason ears will not clear. A swollen nose and throat can block the Eustachian tube, and blocked sinuses cannot equalize either. StatPearls lists active upper respiratory infections and severe sinusitis as relative contraindications because they raise the risk of ear and sinus barotrauma. Trouble can happen on the way back to normal pressure too, when trapped air cannot escape.

• Tell us before your session if you have a cold, stuffy nose, sinus pain, a fever or flaring allergies. Call ahead rather than waiting until you arrive.
• A session may be postponed. Missing a day is far better than an ear injury that pauses your course for longer.
• Do not start a decongestant on your own to get through a session. Ask the physician what is appropriate for you.
• Seasonal allergies count. If you know your allergies flare at certain times of year, mention it at your assessment.

For the other conditions that affect eligibility, see conditions that affect eligibility for HBOT.

Feeling closed in is one of the most common worries, and it is more common in single-person chambers than in larger walk-in ones. In published reports, confinement anxiety made up about 25% of adverse-event reports, and one series recorded it in about 8 per 10,000 treatments. Most anxious patients adjust within their first session or two.

What is in your favor

• You can see out of the chamber.
• Trained staff are in communication with you for the entire session.
• You can ask to stop at any point.

Strategies that many anxious patients find useful

• Tell us in advance. We can walk you through the chamber before your first session so it is familiar.
• Slow your breathing. Breathe in for a count of four and out for a count of six. A longer out-breath helps calm the body.
• Pick a focal point outside the chamber and return your eyes to it when you feel uneasy.
• Check in often. Talking to staff every so often during the first session can be reassuring.
• Book at a calm time of day, not squeezed between stressful appointments.
• Talk to the physician. For some people, the physician may discuss medication to help with the first sessions. That is an individual medical decision, not a routine one.

Learn more about our chamber and the staff who operate it.