Persistent Black Scab in Ear Canal: Causes and When to Seek Help

The skin in the ear canal has dark, crusty areas that do not come off?

Hello, doctor.
About three months ago, while I was cleaning my husband's ears, I noticed a small black spot on the skin of his left ear canal that couldn't be removed.
He visited an otolaryngologist three months ago, who suggested that it might be a scab or eczema resulting from a previous injury while cleaning his ears.
Some of the scab has already fallen off, and currently, there is a small piece about 0.2 mm still remaining in the ear canal.
My husband does not experience any discomfort in his ear, such as itching, tinnitus, or a feeling of fullness.
Occasionally, he has a migraine near his left temple, but he believes it is due to lack of sleep.
He has a history of skin allergies, and I am wondering if the ear canal issue could be related to eczema causing the scab-like material to persist.
For the past three months, he has been applying a thin layer of a topical medication prescribed by the doctor using a cotton swab before bed.
However, I tend to worry easily and am concerned that there might be something harmful on the skin.
Could you please clarify if it is normal for this scab-like material in the ear canal to persist for over three months? Should we consider further examination of the skin or the ear canal?

Liu Xiaojie, 20~29 year old female. Ask Date: 2022/11/11

Dr. Zheng Jueyi reply Otolaryngology

Hello, it's difficult to determine.
If you're concerned, it's advisable to visit an otolaryngologist for a proper examination by a physician to confirm.

Reply Date: 2022/11/11

More Info

Persistent black scabs in the ear canal can be concerning, especially when they do not resolve over time. Based on your description, it seems that your husband has a small black scab in his left ear canal that has persisted for about three months. Initially, it was assessed by an ENT specialist who suggested it might be a result of prior trauma from ear cleaning, leading to scabbing or possibly eczema.
The fact that your husband does not experience any discomfort, itching, tinnitus, or a feeling of fullness in the ear is a positive sign. However, the persistence of the scab raises some important considerations.
1. Possible Causes: The black scab could be a result of several factors:
- Trauma: As mentioned, if the ear canal was injured during cleaning, it could lead to scabbing as part of the healing process.

- Eczema or Dermatitis: Given your husband's history of skin allergies, it's plausible that eczema could be affecting the ear canal, leading to the formation of scabs. Eczema can cause dry, flaky skin that may not heal properly if it is irritated or if the area remains moist.

- Infection: While your husband does not exhibit symptoms of infection (such as pain, discharge, or swelling), it is still a possibility that should not be overlooked. Chronic infections can sometimes present with scabs or crusting.

- Other Skin Conditions: Conditions like psoriasis or seborrheic dermatitis could also lead to similar symptoms.

2. When to Seek Help: Although your husband is not experiencing significant symptoms, it is advisable to have a follow-up consultation with an ENT specialist. Here are some reasons to seek further evaluation:
- Persistence of the Scab: If the scab has not changed in size or appearance over three months, it warrants further investigation to rule out any underlying issues.

- New Symptoms: If he starts experiencing any new symptoms such as pain, discharge, or changes in hearing, it would be essential to seek immediate medical attention.

- Skin Condition Management: Since your husband has a history of skin allergies, it may be beneficial to have a dermatologist evaluate the ear canal to determine if a specific treatment for eczema or another skin condition is necessary.

3. Self-Care and Monitoring: In the meantime, it’s important to avoid inserting cotton swabs or other objects into the ear canal, as this can exacerbate irritation or lead to further injury. Continue applying the prescribed topical medication as directed, but ensure that it is appropriate for use in the ear canal.

4. Conclusion: While the absence of discomfort is reassuring, the persistence of the black scab for three months is not typical and should be evaluated further. A thorough examination by an ENT specialist or dermatologist can provide clarity and ensure that any necessary treatment is initiated. Regular monitoring and avoiding further irritation to the area will be key in managing your husband's ear health.
In summary, while the situation may not be urgent, it is wise to seek further medical advice to ensure that there are no underlying issues that need to be addressed.

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