Recently, we have met several patients who complained of ear congestion and were diagnosed with “pharyngotonsillitis”, “secretory otitis media”, and “tympanic membrane entrapment” in several hospitals, but their symptoms were not relieved for a long time and even worsened. The symptoms were not relieved for a long time and even worsened. Some patients said they only had attacks after waking up, others said they heard breathing sounds in their ears, and some even said they felt their ears flapping and moving. After careful examination by otoscope and tympanic endoscope, the patient’s eardrum was found to be flapping with breathing, and the diagnosis was clear. It turns out to be an abnormal opening of the eustachian tube! In fact, this kind of patient is not too rare in clinical practice, but there are many missed diagnoses, and sometimes it is not easy to distinguish it from eustachian tube infection or secretory otitis media based on the complaints of ear congestion alone. Patients also often feel distended in the ear, and some patients even feel relief when lying down or tilting their head forward, which is somewhat similar to the hearing changes associated with partial fluid accumulation in the tympanic cavity. If the patient has a thick tympanic membrane, the flapping of the tympanic membrane may not always be visible. However, careful questioning, physical examination, and further acoustic conduction, endoscopy can still make the differential diagnosis in most cases. Most patients with this disease are thin, and careful patients sometimes feel a breath sound in their ears, which can be heard if the physician uses a stethoscope connected to an olive head for in-ear auscultation. If tympanic membrane flapping is seen, the patient can be asked to lower the head as much as possible for a few minutes and re-examined. The signs of tympanic membrane flapping can disappear due to stasis of the tissue around the eustachian tube caused by the lowering of the head. However, there are not many satisfactory treatments for this disease. I remember an old patient who talked about how he used to suffer from this disease when he was young, and the doctor who saw him twice blew in boric acid and salicylic acid powder through the catheter with no significant improvement. The patient was not satisfied with the result of the treatment, but he was very sorry for the death of the doctor during the Cultural Revolution.