From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.