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Objective: A systematic review and meta-analysis of the evidence on balloon Eustachian tuboplasty (BET) as a treatment modality for Eustachian tube dysfunction (ETD). We followed the PRISMA guideline and registered with PROSPERO No. CRD42014009461., Data Sources: We searched 12 databases including PubMed and Embase from January 1, 2010, to April 7, 2014, for studies of BET., Endpoints: change in symptoms, middle ear pathology, eardrum status, Eustachian tube function tests, hearing, adverse events, complications, and health-related quality of life., Review Methods: Study quality was assessed using the modified Delphi technique quality appraisal tool for case series studies. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias., Results: Nine case series studies with 443 patients (642 tubes) were included. Population size n=4 (7 tubes) to n=210 (320 tubes). All studies were of poor quality and featured a high risk of bias. We found reduction of patient symptoms in ETD questionnaire (P<.001), postoperative normalization of the tympanic membrane, conversion of type B or type C into type A tympanograms, reduced mucosal inflammation, increased number of positive Valsalva test and Swallowing tests, improvement in Eustachian tube score, reduction in Sino-Nasal Outcome Test (SNOT)-22 score (P=.001), and increased quality of life (P=.001). No serious adverse events were found., Conclusion: The evidence of BET is poor and biased. No firm conclusions can be made to identify patients who will benefit from the procedure or to accurately predict surgical results. Randomized controlled trials or case-control trials are needed., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)