<p>Chronic rhinosinusitis without nasal polyposis (CRSsNP) significantly affects quality of life. This study aimed to compare the efficacy of Balloon Sinuplasty (BSP) and Endoscopic Sinus Surgery (ESS) in managing CRSsNP. A non-randomized controlled trial was conducted including patients diagnosed with CRSsNP. Participants underwent either BSP or ESS based on clinical suitability. Demographic data, symptom severity (SNOT-22), radiological scores (Lund-Mackay), endoscopic findings (Lund-Kennedy), and postoperative complications were evaluated at baseline, 1, 3, and 6 months postoperatively. The BSP and ESS groups were demographically similar (mean age: 25.41 vs. 24.61 years; <i>p</i> = 0.684; gender distribution <i>p</i> = 0.522). Both groups showed significant improvement in SNOT-22 scores. BSP provided better early symptom relief at 1 month (<i>p</i> = 0.027), whereas ESS was more effective at 3 months (<i>p</i> &lt; 0.001), with comparable outcomes at 6 months (<i>p</i> = 0.914). Preoperative Lund-Mackay scores were higher in the ESS group (6.35 vs. 4.89; <i>p</i> = 0.001), indicating more extensive disease. Postoperative scores improved significantly in both groups, with BSP showing lower final scores (0.70 vs. 1.24; <i>p</i> = 0.001). Endoscopic scores improved in both groups, with BSP demonstrating superior early and sustained mucosal healing (<i>p</i> &lt; 0.001 and <i>p</i> = 0.009). Complications were fewer in BSP (21.74%) than ESS (32.61%), though not statistically significant (<i>p</i> = 0.349). Both BSP and ESS are effective for CRSsNP. BSP offers faster recovery, fewer complications, and comparable long-term outcomes, making it a viable minimally invasive alternative, particularly in cases with less extensive disease.</p>