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There are two manifestations of psoriasis on hearing: external ear canal inflammation and conductive loss and sensorineural hearing loss due to cochlear involvement (Fig. 3). With the hyperkeratosis and itching, patients tend to scratch or pick at their ear canals and try to clean them out. This creates a Koebner phenomenon, a hallmark of psoriasis in which the slightest trauma induces further psoriasis formation and expansion (doi. org/10.20431/2456-0022.0303003). Accumulation of scaling and skin debris causes hearing loss, increasing and decreasing edema, and swelling of the cartilaginous ear canal. The scales also make external fitting of hearing aids difficult since the diameters of the ear canal and meatus keep changing. The pressure from wearing hearing aids can also cause