This multinational study prospectively collected SNOT-22 data to determine the prevalence and severity of, and whether endoscopic sinus surgery (ESS) had improved, symptoms of Eustachian tube dysfunction in patient with chronic rhinosinusitis (CRS). The SNOT-22 includes two questions which are related to Eustachian tube dysfunction, namely presence of ear fullness or ear pain, and these are scored from 0 (no problem) to 5 (as bad as it can be). The questionnaire was scored on the day of surgery and again at least three months following FESS. A control group of patients’ family and friends and university and hospital staff had no self-reported nasal or ear disease, chronic conditions or hospital admissions in the preceding 12 months. A total of 131 patients had a completed SNOT-22 on the day of surgery and at a mean of 3.8 months postop. The control group had 251 participants who completed SNOT-22 on a single occasion. Ear fullness and ear pain scores were significantly higher in the CRS group than the control group. Patients with CRS and nasal polyposis did not have higher ear scores than those with CRS alone. In the CRS group, 80 patients scored more than 1 for ear fullness and 66 completed the whole study; there was a statistically significant decrease in mean ear fullness score post operatively and 79% of patients reported an improvement in their score. Five patients reported worse scores postoperatively. Thirty-nine patients scored more than 1 for ear pain and 30 went on to complete the postoperative SNOT-22. Mean ear pain significantly decreased post-ESS and 73% reported an improvement in their ear fullness score. Three patients reported symptom deterioration. The authors comment that Eustachian tube dysfunction has not been fully investigated in the setting of CRS and ESS and that this study shows it has a high prevalence and does seem to respond to surgery. They recognise that their follow-up period is short and that tympanometry may be of benefit as an objective measure, and also that a specific Eustachian tube dysfunction questionnaire could be used. One would think it would be fairly straightforward also to increase the study numbers bearing in mind the huge number of SNOT-22 questionnaires that have been filled in by our CRS patients over the last 20 years.