Balloon dilation of the Eustachian tube has recently been introduced as a novel and minimally invasive method for treating chronic obstructive Eustachian tube dysfunction. For the first time worldwide, we assessed the role of this technique in a large cohort of children with Eustachian tube dysfunction that did not respond to other treatments and in whom a tumor could be ruled out as the cause.This study is a retrospective analysis.We retrospectively analyzed the medical records of 66 children (mean age 8.12 years, range 4-14 years) who underwent balloon dilation of the Eustachian tube using the Bielefeld balloon catheter.There were no complications during surgery. Clinical symptoms improved in more than 80% of the patients. No patient reported a deterioration of symptoms. Of the participating parents, over 80% were very satisfied or satisfied with the treatment outcome.Balloon dilation is a rapid, simple, and safe method for treatment of both adults and children with Eustachian tube dysfunction that does not respond to other treatments. Further studies, ideally multicenter studies, are required in order to optimize the definition of existing and potential new indications for this treatment approach, as well as to establish this treatment in the management of children with refractory chronic Eustachian tube dysfunction.