The patulous eustachian tube is a benign, yet annoying condition that may be over-looked or misdiagnosed. It is frequently associated with peritubal atrophy, and usually responds to conservative measures such as weight gain or mucus-producing agents. In patients not responding to these measures, a variety of surgical options are available. We have been using a technique that avoids elevating a tympanomeatal flap, is reversible, and is effective. This technique, as well as other surgical options, are reviewed. The advantages and disadvantages inherent in them are discussed.