Background: To determine the effectiveness of the Eustachian tube balloon dilatation procedure by comparing tympanometry, audiometry, Visual Analog Scale, mucosal inflammation score, and related otoscopy findings in patients who were given nasal steroid spray Methods: The patients were divided into 2 groups that included 20 patients each: as the groups undergoing Eustachian tube balloon dilation and that using nasal decongestant with nasal steroid spray. Results: All cases were successfully dilated without major complications. There was a significant difference in the Visual Analog Scale score, third-month pain, and membrane findings. No significant difference was found in the mucosal inflammation score, air-bone gap improvement, intranasal volume values, and computed tomography findings. Conclusion: This study demonstrated that balloon dilation of the cartilaginous portion of the Eustachian tube was more effective than nasal steroid treatment without significant complications.