Inclusion Criteria:  Patients are included in the study if they have presented constant or intermittent ETD symptoms for more than three months:  pressure in the ears, pain in the ears, a feeling that the ears are clogged or "under water", ear symptoms when having a cold or sinusitis, crackling or popping sound in the ears, ringing in the ears, feeling that the hearing is muffled.  Furthermore, objective signs of negative middle ear pressure are needed:  poorly retractable eardrum, tympanometry compatible with negative middle ear pressure (C2 or B-curve).  Exclusion Criteria:  patient refusal to participate in the study, head and neck surgery in the previous three months, head and neck irradiation, ETD symptoms <3 months, adenoid hypertrophy, nasal polyposis, acute upper respiratory infection or acute sinusitis, tympanic membrane perforation, age <18 years, cleft palate, craniofacial syndromes including Down's Syndrome, cystic fibrosis, ciliary dysmotility syndrome.