Objectives: To evaluate the effect of balloon Eustachian tuboplasty on the results of surgical reconstruction of subtotal tympanic membrane perforations in cases of resistant Eustachian tube dysfunction. Design: Prospective randomized study. Setting: Tertiary care university hospital. Patients: Seventy-two patients with dry subtotal tympanic membrane perforations and resistant Eustachian tube dysfunction, aging 19–51 years, were distributed randomly in two groups A and B. Interventions: Both groups underwent underlay myringoplasty using temporalis fascia graft. In group A, myringoplasty was preceded by balloon dilatation of the cartilaginous Eustachian tube. Main outcome measures: Graft take rate, hearing results and middle ear pressure. Results: Graft take rate at 12 months postoperative showed a significant difference between the two groups where it was 89.2% in group A (33 of 37 cases) and 80% in group B (28 of 35 cases). Pure tone audiometry results at 12 months postoperative showed a significant improvement of air conduction curves at all frequencies in both groups. The middle ear pressure was significantly better in group A at 6 months (mean pressure: 29 daPa in group A, 60 daPa in group B) and at 12 months postoperative (mean pressure: 55 daPa in group A, 79 daPa in group B) Conclusion: Balloon Eustachian tuboplasty is a safe, easy and effective procedure that yields better results in reconstruction of subtotal tympanic membrane perforations in cases of resistant Eustachian tube dysfunction.