Squidward is playing his clarinet when SpongeBob goes outside to do some gardening. He think Squidward went to an Italian restaurant called Mario's. Suddenly, SpongeBob notices two construction workers putting up a billboard. Thinking Squidward's music is flatulence, SpongeBob becomes noisy to cover it up, until Squidward alerts him to stop. Getting mad at the billboard workers, he then discovers the Bikini Bottom Symphony Orchestra is holding a competition for an original score. Following a series of events starting with Patrick breaking his butt, Squidward tries not to get distracted by SpongeBob's home doctoring. After turning in his score, he finds that he wrote down all of SpongeBob's doctoring. He finds SpongeBob squeezing a rubber duck and Patrick going "Woo!" and SpongeBob is on a seat, bashing Patrick's brain, causing a farting noise and making his eyes pop out.
The audience gave a round of applause to Squidward. SpongeBob says to make sure Squidward doesn't get a "swelled head". The camera cuts to only Squidward, whose head inflates due to Patrick squeezing the pump of the blood pressure, and the episode ends by the screen blacking out as an explosion is heard.
When Squidward finally finishes writing his song, he has that same look on his face that he had in the episode Squid's Day Off, when he locked himself in his house. However, sand was added into his eyes in this episode.
The machine that Patrick was in was exactly like the one SpongeBob was dreaming about the laughing machine in "Funny Pants".
When "The Splinter" premiered, this episode also aired along with it.
In "Suds", and "The Splinter" Patrick pretended to be a doctor and treated SpongeBob. This time, the tables are turned: SpongeBob pretends to be a doctor and treats Patrick.
It is not known because if Squidward needed silence to concentrate, it never occurred to close the window.
The first time SpongeBob puts on a rubber glove and makes that squeaky sound and Patrick goes "Woo!", may have implied that SpongeBob was giving Patrick a prostate exam. However, he was just playing with a rubber duck that amused Patrick.
Dish Network calls this episode "Suctioncup Symphony".
The symphony the orchestra plays may have been from Heroes of the Bible: Lions, Shepherds and Queens (Oh My!)
Squidward would have seen "Bikini Bottom Symphony Orchestra" on the billboard since "Original Compositions Wanted" was the part that wasn't visible.
All the music players still continued playing their instruments after the music ended.