Individuals with XLI appear at increased risk of developmental disorders such as autism and Attention Deficit Hyperactivity Disorder and some affected individuals exhibit mood problems  Mood problems in XLI appear to be most influenced by stigma or bullying associated with the skin condition, and by difficulties with treating the skin condition. Individuals with XLI can exhibit intellectual disability, although this is thought to be due to deletions encompassing neighboring genes (e.g. VCX) in addition to STS.Female carriers generally do not experience any of these problems but can have difficulty during childbirth, as the STS expressed in the placenta plays a role in normal labor. Female carriers may also be at slightly increased risk of developing mental health problems following childbirth  For these reasons carriers should ensure their obstetrician is aware of the condition. Genetics
The STS gene is located on the X chromosome at band Xp22.3. Thus, the syndrome is an X-linked condition, and it affects males and females differently. The 23rd pair of chromosomes is typically termed the "sex chromosomes". Females have two X chromosomes and males have one X and one Y chromosome. Therefore, in normal individuals, males carry a single copy of the STS gene and females carry two copies. This gene partially escapes X-inactivation and females normally express higher amounts of the STS enzyme than males.XLI can occur through new deletions or mutations of the STS gene but is more commonly inherited from a carrier mother.
When circumstances cause overall body fat to diminish, the tissue surrounding the Eustachian tube shrinks and this function is disrupted.Activities and substances which dehydrate the body have the same effect and are also possible causes of patulous Eustachian tube. Examples are stimulants (including caffeine) and exercise. Exercise may have a more short-term effect than caffeine or weight loss in this regard. Pregnancy can also be a cause of patulous Eustachian tube due to the effects of pregnancy hormones on surface tension and mucus in the respiratory system.Granulomatosis with polyangiitis can also be a cause of this disorder. It is yet unknown why. PET can occur as a result of liquid residue in the Eustachian tube, after suffering a middle ear infection (otitis media). Radiation therapy
High levels of estrogen
Nasal decongestants
Stress
Sudden weight loss
Neurological disorders

Diagnosis
Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly view the tympanic membrane with a light and observe that it vibrates with every breath taken by the patient. A tympanogram may also help with the diagnosis. Patulous Eustachian tube is likely if brisk inspiration causes a significant pressure shift. Patulous Eustachian tube is frequently misdiagnosed as standard congestion due to the similarity in symptoms and rarity of the disorder. Audiologists are more likely to recognize the disorder, usually with tympanometry or nasally delivered masking noise during a hearing assessment, which is highly sensitive to this condition.When misdiagnosis occurs, a decongestant medication is sometimes prescribed.