Eustachian tube dysfunction has long provoked debate among otolaryngologists with wide-spread variation in management. Establishing a safe and effective surgical technique to bring about resolution would be of benefit to those affected, with an estimated incidence of 0.9% in the UK. This well-constructed article takes a pragmatic approach to evaluating the current evidence through a case series review of cartilaginous dilatation. Pre- and post-operative parameters of tympanometry, otoscopy findings, valsalva and subjective symptoms were used focusing on short term (<6 months) and long term (>6 months). The literature demonstrates balloon dilatation performed on 375 eustachian tubes from 235 patients with clear short-term benefits across the aforementioned outcome measures. A complication rate of 3% was observed, yet these were deemed minor and short-lived. Indeed, in the absence of bony dilatation the practice of a routine pre-operative CT scan is questioned by the authors. The stage appears set for the eventual evolution of its use in mainstream practice, although the authors sensibly emphasise the importance of formalised training and meticulous review of outcomes.