For exceptionally wide ET openings, manifested by disturbing autophony, the concentrated PatulEND®20 formula is also formulated to produce new collagen, increased tubal strength, and hydration of the membrane lining the ET so that there is a seal of the liquid surface contact by the process of sympexis. The concentrated formula is enhanced to close the Eustachian Tube, together with the production of new collagen for the Eustachian Tube tissues to develop the strength and mucosal surface tension necessary – referred to as sympexis – for an effective tube closure. PatulEND®20 builds up new tissue and stronger collagen for a tighter seal to eliminate the symptoms of DiBartolomeo’s Syndrome. Suggested Use: Tilt head back 45°, then tilt towards affected side. Place the spray tip inside the affected side entrance of your nostril. Cover the other nostril with finger or hand to create a seal and gently spray 1-2 times while simultaneously inhaling though nose targeting the PET canal. A mild stinging sensation will indicate that the target location was reached. Use up to 2 times a day or as needed. Keep refrigerated after opening to preserve potency.