Learning Objectives: Symptoms of ETD may be confusing to the patient and the physician evaluating the condition. Obstructed ET may have symptoms of aural pressure, otalgia, popping, snapping, hearing loss, tinnitus, disequilibrium, and even vertigo. Patients with patulous ET may complain of aural pressure, otalgia, fullness, autophony of breathing or voice and habitual sniffing. Although there is a certain degree of overlap of the symptoms, a careful history taking should be able to differentiate these two conditions. However the main and absolute difference is in the findings in examination and testing. While continuously patulous ET has pretty straightforward symptoms and findings, the semi-patulous ET, with a very low ET opening pressure and closing pressure, or the ET that intermittently becomes patulous may be more difficult to diagnose and differentiate from the obstructed ET.

There are exciting new developments regarding the examination, testing and treatment of ETD. More recently, a number or new surgical procedures to improve the ETD are described. Naturally, the surgical treatment methods for obstructed versus patulous ET are different, while former aims widening the ET lumen, the latter needs to tighten it. If the type of ETD is not accurately diagnosed, there is greater chance for a diagnostic error. If a treatment for reducing the ET resistance is applied to a patulous or semi-patulous ET, the condition will worsen. Although less likely, if a procedure to increase the ET resistance is applied to an ET with obstruction, condition will get worse.

Differentiation of patulous versus obstructed ETD can be made with otoscopy, otomicroscopy, otoendoscopy, Valsalva, Toynbee, sniffing, tympanometry, 9-step test, inflation and deflation test, sonotubometry, forced response test, tubomanometry and pressure chamber tests. Tests can accurately differentiate patulous ET and ET obstruction, risk of worsening of the patulous or obstructive ETD with surgical interventions may be prevented.