Objectives: There has been anecdotal evidence that otalgia and ear fullness are associated with a deviated nasal septum (DNS). The goal of this novel, pilot study is to evaluate if eustachian tube dysfunction (ETD) is associated with a DNS and improved following septoplasty. Design: Prospective comparative pilot study Setting: Tertiary hospital at an academic institution Participants: Twenty-five patients with septal deviations (16 with otalgia and 9 controls) underwent septoplasty with inferior turbinate reduction between November 2016 and May 2018. Main Outcome Measures: ETDQuestionnaire (ETDQ-7), Sino-nasal Outcome Test (SNOT-22), and Nasal Obstruction Symptom Evaluation (NOSE) assessed quality of life pre and post operation. Results: Mean SNOT-22 scores decreased significantly for both groups (p< 0.05). The results of the ETDQ-7 showed aural symptoms significantly decreased for case patients at 6 weeks (-17.4, p=0.016) which continued through week 12. Symptoms of ear fullness and pain were significantly reduced in the case group (p<0.05). With both groups experienced a reduction in all questionnaires, decreased SNOT-22 scores correlated with ETDQ-7 (p=0.0012) and NOSE (p<0.036) improvements while the control group did not see test correlations. Conclusions: Overall, our study demonstrated otalgia or ear fullness could be associated with a DNS. The data suggests significant correlations between all three questionnaires in evaluating patients with nasal obstruction and aural symptoms, and that they are reasonable tools in evaluating ETD outcomes concerning septoplasty. Thus, we propose that nasal septum deviation be evaluated and included in any algorithm for the diagnosis and management of patients with ETD.