These features are provided by the history, the otologic examination, and the hearing tests:I. The history may reveal a discharging ear or a previous ear infection. A feeling of fullness, as if fluid were trapped in the ear, may accompany the hearing loss, or a sudden unilateral hearing loss may follow an effort to clean out wax with a fingertip. There may be a history of a ruptured or perforated eardrum or of head trauma. Often the hearing loss is of gradual onset and is aggravated by pregnancy. The hearing loss may even have been present at birth, or it may have been noted in early childhood.