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Background: To elucidate the role of balloon Eustachian tuboplasty (BET) in the management of chronic rhinosinusitis with obstructive Eustachian tube dysfunction (ETD), we evaluated the results of endoscopic sinus surgery (ESS) with and without BET in patients with chronic rhinosinusitis with obstructive ETD. Methods: This randomized controlled trial conducted in a single‐institution tertiary care center setting included 50 patients diagnosed with primary chronic rhinosinusitis and obstructive ETD between July 2018 and June 2022. Twenty‐five patients were prospectively enrolled for combined ESS/BET. The control group (25 patients) underwent ESS alone. Outcome measurements of the Sinonasal Outcome Test 22, modified Lund–Kennedy score, Eustachian Tube Dysfunction Questionnaire‐7 (ETDQ‐7), and serial Eustachian tube function test results were analyzed 3 months postoperatively. Results: The improvement (12.60 ± 6.50) in the ETDQ‐7 score in the BET group was significantly higher than that in the control group (6.60 ± 5.58). The ratio of improvement in the ETDQ‐7 score was also significantly higher in the BET than in the control group (92% vs. 68%, p = 0.034). Logistic regression analysis showed that performing BET (odds ratio [OR]: 5.41, 95% confidence interval [CI]: 1.02–28.79, p = 0.048) and a low post‐modified Lund–Kennedy score (OR: 0.15, 95% CI: 0.04–0.54, p = 0.004) were significantly associated with ETDQ‐7 score improvement. Conclusion: Combined BET/ESS could decrease otologic symptoms and improve Eustachian tube function. BET may be an appropriate adjunctive procedure for treating chronic rhinosinusitis with obstructive ETD. [ABSTRACT FROM AUTHOR]