Background: Chronic rhinosinusitis (CRS) significantly impacts the quality of life in pediatric patients, particularly when symptoms persist despite adenoidectomy and optimal medical therapy. Balloon catheter dilation (BCD) has emerged as a minimally invasive alternative to functional endoscopic sinus surgery (FESS), offering potential benefits in symptom resolution and safety. This study evaluates the efficacy and safety of BCD in children with refractory CRS. Methods: A total of 50 pediatric patients (ages 4–12) with persistent CRS following adenoidectomy were included. Patients underwent BCD, and symptom improvement was assessed using the Sinonasal 5 (SN-5) questionnaire at 3, 12, 24, and 52 weeks post-operatively. Success was defined as a ≥0.5-point reduction in SN-5 scores. Complications were monitored, and statistical significance was determined (p < 0.05).  Results: A significant improvement in SN-5 scores was observed, with a mean reduction of 1.8 points (p < 0.001). The success rate was 85%, with 45% experiencing significant improvement (>1.5-point reduction), 25% moderate improvement (1.0– 1.4), and 15% mild improvement (0.5–0.9). Only 15% were classified as surgical failures. The overall complication rate was 12%, with minor intraoperative events, including mucosal trauma (2%) and self-limiting bleeding (2%). Postoperative complications included nasal congestion (4%), mild epistaxis (2%), and sinus infection (4%). No major adverse events were reported, and only 4% required additional surgical intervention. Conclusion: BCD is a safe and effective intervention for pediatric CRS patients unresponsive to adenoidectomy, offering substantial symptom relief with minimal complications. It presents a promising alternative to more invasive surgical options.