What could be causing my dry and itchy ears with scabs on the inside and outside, along with diminishing hearing, that has been ongoing for a month?

Dry, Itchy Ears with Scabs and Hearing Loss

You most likely have either acute otitis externa (ear canal infection) or ear canal dermatitis (eczema/seborrhea), and you need to see a healthcare provider urgently to distinguish between these conditions and receive appropriate treatment—this is critical because the hearing loss suggests significant canal obstruction from debris/scaling that requires professional cleaning.

Immediate Assessment Needed

Your symptoms require urgent evaluation because:

• Hearing loss indicates canal obstruction from accumulated debris, scales, or inflammatory material that must be professionally removed before any treatment can work effectively 1
• The combination of scabs on both inside and outside of the ear suggests either severe otitis externa with extension or underlying dermatologic condition (eczema, seborrhea, contact dermatitis) 2
• One month duration without improvement is concerning and suggests either treatment failure, wrong diagnosis, or a complicating factor like fungal infection or contact dermatitis 1

Most Likely Diagnoses

If This Is Acute Otitis Externa (Infection):

• Bacterial infection (most commonly Pseudomonas aeruginosa or Staphylococcus aureus) causes ear canal inflammation with itching, discharge, and canal obstruction 1, 3
• The scabbing and crusting suggest chronic or severe infection, possibly with secondary dermatitis 1
• Hearing loss occurs from debris buildup blocking the canal, not from inner ear damage 1

If This Is Ear Canal Dermatitis:

• Atopic dermatitis presents with chronic itching, dry scaling, and lichenification (thickened skin) 2
• Seborrheic dermatitis causes greasy yellowish scaling with itching 2
• Contact dermatitis from jewelry, hearing aids, or topical medications causes persistent erythema, scaling, and crusting 2, 4
• Dermatitis can cause secondary bacterial or fungal infection, especially after one month 1, 2

Critical Next Steps

1. Professional Ear Cleaning (Aural Toilet) - ESSENTIAL FIRST STEP

• You cannot treat this effectively without professional debris removal - medication cannot penetrate through accumulated scales and debris 1
• This requires gentle suction or dry mopping under visualization by a healthcare provider 1
• The American Academy of Otolaryngology-Head and Neck Surgery emphasizes this must be done before any drops are administered 1

2. If Bacterial Infection (Otitis Externa) Is Diagnosed:

First-line treatment:

• Topical antibiotic/steroid drops (such as ofloxacin 0.3% or ciprofloxacin 0.2% with hydrocortisone) for 7-10 days 1, 5
• These achieve cure rates of 65-90% within 7-10 days 1
• Avoid neomycin-containing drops if you have any history of skin allergies or eczema - neomycin causes allergic reactions in 13-30% of patients with chronic ear problems 1, 2

Important considerations:

• If you have diabetes or immune problems, you need more aggressive treatment with possible oral antibiotics because you're at higher risk for serious complications 1
• Pain should improve within 48-72 hours; if not, you need reassessment 1

3. If Dermatitis Is Diagnosed:

First-line treatment:

• Topical corticosteroid drops or ointments for 7-10 days, potentially extending to 2 weeks 2
• For seborrheic dermatitis, add topical antifungal medication to reduce yeast burden 2
• For contact dermatitis, immediately remove any potential triggers (jewelry, hearing aids, topical medications) 2, 4

Long-term management:

• Regular emollient use after bathing to prevent water loss 2
• Intermittent anti-inflammatory treatment as needed 2
• Keep nails short to minimize trauma from scratching 2

High-Risk Scenarios Requiring Urgent Evaluation

Seek immediate medical attention if you have:

• Swelling extending beyond the ear canal to the face or neck - this requires oral antibiotics 1
• Severe pain that's worsening or not responding to over-the-counter pain medication 1
• Diabetes or immune compromise - you're at risk for necrotizing otitis externa, a serious complication 1
• Fever, severe headache, or neurological symptoms - these suggest serious complications 4

Why This Has Persisted for One Month

Common reasons for treatment failure include:

• Inadequate debris removal - medication cannot reach infected tissue through scales and crusts 1
• Fungal co-infection (otomycosis) - especially likely after prolonged symptoms, presents with white fuzzy debris and intense itching 1
• Allergic contact dermatitis from previous treatments (especially neomycin or hydrocortisone) - causes persistent redness, itching, and scaling despite treatment 1, 2
• Wrong diagnosis - treating infection when it's actually dermatitis, or vice versa 1, 2
• Underlying skin condition (eczema, psoriasis, seborrhea) that hasn't been addressed 2

Critical Pitfalls to Avoid

• Do NOT use cotton swabs or insert anything into your ear - this worsens inflammation and pushes debris deeper 1
• Do NOT use over-the-counter ear drops without medical evaluation - you may have a perforated eardrum (especially if you taste anything you put in your ear), which requires specific non-ototoxic medications 1
• Do NOT assume this will resolve on its own - one month of symptoms with hearing loss requires professional intervention 1
• Keep your ears dry during treatment - water exposure worsens both infection and dermatitis 1, 2

Expected Timeline

• With appropriate treatment, symptoms should improve within 48-72 hours 1
• Complete resolution typically occurs within 7-10 days for infection 1
• Dermatitis may require 2 weeks of treatment and long-term maintenance 2
• If no improvement occurs within 48-72 hours of starting treatment, you need reassessment for alternative diagnosis or complications 1

Bottom line: See a healthcare provider urgently for proper diagnosis, professional ear cleaning, and appropriate treatment. The hearing loss and one-month duration make this a priority that cannot be managed with home remedies alone.