A system effectively narrows a patulous Eustachian tube (ET) of a patient with a guide catheter, instrument, and insert. The guide catheter includes a shaft, a lumen and a distal end configured to provide access the ET when the guide catheter is inserted into a head of the patient. The instrument comprises a shaft. The insert comprises a body configured to radially expand and retract between a non-expanded state and an expanded state. The insert is sized and shaped to be received within the first lumen when in the non-expanded state and is operable to expand to the expanded state to substantially reduce an effective diameter of the ET.
