Balloon catheter dilation (BCD) is a treatment paradigm for surgical management of paranasal sinus inflammatory disease. There are few robust clinical trials evaluating the efficacy of balloon technology in chronic rhinosinusitis (CRS). The available database largely comprises retrospective, uncontrolled studies with insufficiently characterized patient cohorts and a lack of comparator groups. Thus, the current evidence base is unable to elucidate the role and indications for BCD in the management of medically refractory CRS. Future studies should include selected control groups, preferably with randomization and validated outcome measures, to determine the efficacy of balloon technology compared with endoscopic sinus surgery.