Different surgical techniques have been developed in order to dilate the cartilaginous portion of the Eustachian tube (ET), the site of most pathology, including laser tuboplasty, tissue ablation using the microdebrider and more recently balloon dilation. The osseous segment of the ET, sharing an intimate party wall with the internal carotid artery, should be treated carefully as injury to the artery is possible and dilation with a noncompressible balloon is not recommended. Balloon dilation of the cartilaginous segment of ET through a transnasal endoscopic approach has gained popularity among the other surgical techniques such as laser or microdebrider for treatment of resistant ET dilatory dysfunction (ETD). There is accumulating evidence that transnasal endoscopic balloon dilation of the cartilaginous portion is becoming the main approach for ETD. Numerous studies have shown improvement in multiple assessments of ET function after balloon dilation including: ability to perform a Valsalva, improvements in tympanograms, atelectasis, tubomanometry, mucosal inflammation scores, mean ETDQ-7 symptom scores, and other ET measurements. Likewise, there is mounting evidence that outcomes after balloon dilation are durable to at least 2.5 years in regards to being able to perform a Valsalva manoeuvre, improvement in tympanograms and by the mucosal inflammation score.