Objective: To compare local anesthesia (LA) versus general anesthesia (GA) for balloon dilation of the Eustachian tube (BDET) using the Bielefeld Dilation System in a Chinese population with obstructive Eustachian tube dysfunction (OETD).Methods: A total of 49 patients with OETD undergoing BDET under either LA or GA were included in the present study. Intraoperative blood pressure, heart rate, and pain sensation were recorded. The surgical outcome was assessed by Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) symptom scores and positive Valsalva maneuver at baseline, 1 day, 2-, 4-, 12-, 24-, and 52-week follow-up.Results: Balloon dilation of the Eustachian tube procedures were successfully completed in all patients without adverse effects. The visual analog scale score for maximal pain during the surgical procedure in the LA group was 6.1 ± 1.0. Intraoperative blood pressure and heart rate were higher in the LA group compared with the GA group. The duration and costs of surgery were significantly reduced in the LA group compared with the GA group. Normalization of ETDQ-7 scores at 12-week and 52-week follow-up was observed in 71.9% (23/32) and 63.3% (19/30) of patients in the LA group, respectively, which was comparable to that of the GA group. Although improvement in positive Valsalva maneuver was observed in both groups after BDET, more patients reported positive Valsalva maneuver in the GA group compared with the LA group at 12-week and 52-week follow-up. In total, 96.0% (24/25) of patients in the LA group and 95.8% (23/24) of patients in the GA group would choose LA if BDET was needed again.Conclusion: Balloon dilation of the Eustachian tube under LA is safe and feasible in a Chinese population. The surgical outcome of BDET is comparable between under LA and GA during 52-week follow-up. Further studies are needed to address management of intraoperative pain and determine longer follow-up outcome for BDET under LA.