Surfer’s Ear and Summer ENT Risks: What Pharmacists Need to Know
Irish Pharmacy News interview with Dr Marcus Choo, ENT Consultant at Sligo University Hospital
Source: Irish Pharmacy News, May 2026, pages 26 and 28.
As Ireland’s love of open water swimming, surfing and coastal activities continues to grow, so too does the incidence of ear-related conditions linked to water exposure. While ‘swimmer’s ear’ is widely recognised, another condition, surfer’s ear, remains less well understood, despite being surprisingly common in Ireland’s climate.
Dr Marcus Choo, ENT Consultant at Sligo University Hospital, highlights the importance of awareness, early recognition, and prevention — particularly for community pharmacists who are often the first point of contact for patients presenting with ear complaints.
A hidden but common condition
Surfer’s ear, clinically known as exostoses, is a condition where the ear canal develops bony growths in response to repeated exposure to cold water. Unlike many ear conditions, it develops gradually and is often asymptomatic in its early stages.
“Typically, the risk of developing clinically evident surfer’s ear increases in proportion to time spent in cold water,” explains Dr Choo. “Around 66% of Irish surfers have evidence of the condition, although most are unaware they have it.”
Ireland’s climate plays a significant role. With water temperatures rarely exceeding 17°C, even seasonal or recreational water users are at risk.
“It’s not just surfers,” Dr Choo notes. “Open water swimmers, triathletes and kayakers are all susceptible. As participation in these activities has increased over the past decade, we’re seeing a corresponding rise in cases.”
Surfer’s ear vs swimmer’s ear
One of the key challenges in practice is distinguishing surfer’s ear from swimmer’s ear (otitis externa), as patients often use the terms interchangeably.
Swimmer’s ear is an infection of the outer ear canal, typically caused by water trapping and subsequent bacterial or fungal growth. It is particularly common in warm, humid environments but is also frequently seen in Ireland among pool users and open water swimmers.
Surfer’s ear, by contrast, is not an infection but a structural change in the ear canal. Symptoms usually only develop once the canal becomes significantly narrowed.
“When the canal is blocked by 70–80%, water and wax can become trapped,” says Dr Choo.
“This can lead to a feeling of blockage, hearing loss, and eventually infection.”
Recognising symptoms and red flags
For pharmacists, recognising the difference between routine ear complaints and more serious issues is essential.
Patients with surfer’s ear may initially present with:
- A sensation of blocked ears
- Reduced hearing
- Recurrent infections
Pain, swelling or discharge usually indicates a secondary infection.
Swimmer’s ear, on the other hand, often presents with:
- Ear pain, particularly when touching the ear
- Swelling at the entrance of the ear canal
- Discharge
It may also occur following swimming or water exposure, particularly in warm or crowded environments.
Dr Choo advises that certain symptoms should prompt immediate referral:
- Persistent pain or discharge
- Hearing loss
- Fever
- Bleeding from the ear
- Severe or spreading redness
- Vertigo
“These can indicate that the infection is spreading beyond the ear canal and require urgent medical attention,” he says.
When to refer
Pharmacists play a key triage role in identifying when patients should be referred for further assessment.
“Anyone with persistent symptoms — particularly pain, discharge or hearing loss — should be assessed by a GP,” says Dr Choo. “If there is suspicion of a perforated eardrum, non-ototoxic drops should be used.”
Patients with recurrent infections or ongoing symptoms should be referred to an ENT specialist, particularly if surfer’s ear is suspected.
In more advanced cases, surgical intervention may be required.
“This involves widening the ear canal under general anaesthetic,” Dr Choo explains. “Recovery can take up to six weeks before water activities can resume.”
Prevention: a key role for pharmacists
Given the link between cold water exposure and surfer’s ear, prevention is critical — and pharmacists are well placed to advise patients on practical strategies.
“Anything that reduces cold water entering the ear canal will help,” says Dr Choo.
Recommended measures include:
- Wearing ear plugs during water activities
- Using swim caps or hoods in colder conditions
- Ensuring ear plugs are comfortable and properly fitted
“The type of ear plug is less important than whether the patient will actually use it,” he adds. “Encouraging patients to try different options can improve compliance.”
For patients prone to swimmer’s ear, additional measures may help:
- Using alcohol-based ear drops after swimming to evaporate trapped water
- Placing Vaseline-coated cotton wool in the ears before swimming
- Avoiding water retention in the ear canal
Interestingly, despite awareness of the risks, compliance with protective measures remains inconsistent.
“Many people know they should use ear plugs but don’t,” says Dr Choo. “Comfort, cost and reduced hearing are common barriers — and sometimes it’s simply habit.”
Common summer presentations
During the summer months, swimmer’s ear remains the most common ear complaint seen in pharmacy.
“Increased water exposure, travel to warmer climates, and crowded swimming environments all contribute,” Dr Choo explains.
The most common bacterial causes include Staphylococcus aureus and Pseudomonas aeruginosa, which should be considered when selecting appropriate treatment.
Pharmacists should also be aware of broader ENT risks associated with summer.
The overlooked role of UV exposure
While ear infections are a key concern, Dr Choo emphasises that UV exposure remains a significant but often under-recognised issue.
“The ears are constantly exposed to the sun, yet often overlooked when applying sun protection,” he says.
Despite Ireland’s climate, skin cancers remain common, and the ears are a frequent site of concern.
“Protecting the skin, including the ears, is a simple but effective way to reduce risk,” he adds.
Public health messaging
From a prevention perspective, Dr Choo highlights several key messages pharmacists can reinforce:
- Protect ears from prolonged cold water exposure
- Use ear plugs, swim hats or hoods where appropriate
- Avoid inserting cotton buds into the ear canal
- Use olive oil sprays to maintain ear canal health
- Seek early advice for persistent symptoms
For patients with recurrent infections, having antibiotic ear drops available when travelling may also be beneficial.
“Pharmacists are ideally placed to deliver these messages,” he says. “They are accessible, trusted, and often the first point of contact.”
Supporting better awareness
Ultimately, improving awareness of conditions such as surfer’s ear — alongside more common issues like swimmer’s ear — is key to reducing long-term complications.
As water-based activities continue to grow in popularity, so too does the need for proactive education and prevention.
“Simple measures can make a significant difference,” concludes Dr Choo. “With the right advice and early intervention, many of these conditions are entirely preventable.”
