The patulous Eustachian tube (tuba aperta) is a benign condition that may be overlooked or misdiagnosed. It is a distressing condition for the patient with such symptoms as autophony and a sensation of fullness in the ear. One third of the women with the diagnosis are pregnant or taking oestrogens. The diagnosis is made by the history of fullness or blockage and hearing one's own voice and breath in the ear. The drum is usually atrophic and moves with respiration but this may not be visible. The usual past history is of weight loss. The patulous Eustachian tube is frequently associated with peritubal atrophy, and usually responds to conservative measures such as weight gain. The application of nose drops is wrong. Why some patients with a patulous tube and movement of the drum with respiration have no symptoms and other patients with very bothersome symptoms have so few objective signs and no movement of the drum that can be observed with respiration, remains a mystery.