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You probably cannot be certain w/o a CT (or back in 1998 it was the surgical procedure when mine was discovered!). I think CT scans have vastly improved. If you have thick, granular, possibly grey or bizarre colored gunk coming from your ear, that might be a good indication. If you have severe ear pain that feels like your ear IS about to burst, that may be an indicator. If you've had these and you go undiagnosed (bad doctor or you've not seen any doctor), eventually you'll probably get pain in the mastoid bone (behind ear) and a very disturbing CLOGGED ear/face....if it proceeds untreated you may find your facial nerve affected. It would feel like your foot does when it falls asleep. Headaches that come on after one or several of the symptoms I described. Headaches that interrupt your thinking process....I had those too. One sided, the C-toma side (ONLY). ALL symptoms were ONLY one-sided.