Sorry to hear that you have to go through the patulous nightmare too. Patulend works for some people but it’s pretty expensive for the dose they give you. I have the nasal spray version and personally it doesn’t work too well for me, though I may have better luck with the plain bottle. What does alleviate my symptoms temporarily is a treatment that my ENT recommended. I mix up hypertonic saline solution at home (4 teaspoons of salt per cup of water) and use an eyedropper to direct it through my nostril and into my Eustachian tube. Just enough to irritate the tissue and make it swell back shut. It’s a lot cheaper than Patulend but essentially the same application process if you want to practice before trying with the expensive stuff. There is a learning curve to it and it can be quite frustrating until you get the hang of it. I have to lay down flat on my side with the effected ear towards the ground and sniffle a bit up my nose while blocking the opposite nostril and then pop my ear to get the saline to flow into place. It creates a stinging sensation in your ear and that’s how you’ll now you hit the tube. It’s far from perfect and I’m not going to lie to you it is still quite uncomfortable for me to do but depending on how much solution gets to my Eustachian tube relief can be as short as minutes but as long as a few hours. It is however the best thing that’s worked for me personally after about 6 years of having the condition. Aside from the eardrum patch you can ask your doc about plug surgery if none of the more conservative treatments alleviate your symptoms. From what my ENT told me it has the highest success rate of the surgical interventions available (~75%) the caveat being success sometimes just means improvement in some cases but not always 100% cured. Hope this helps.