That depends on a lot of factors. Balloon sinuplasty is a good procedure and can help people significantly, but it also reimburses well, so there are a lot of physicians out there that are performing the procedure on patients that really do not need the procedure. Specifically patients who have what is called atypical facial pain. Patients with atypical facial pain have facial pain and pressure that patients often think are sinus infections. But their CT scan, when they are symptomatic are completely normal. If you balloon these patients, for unknown reasons, their facial pain improves temporarily, but it does come back (usually sooner than 4 years though). So you could be having a relapse of symptoms because you have atypical facial pain which is like a migraine but located over the face. If this is the case you need to see a neurologist. One other option (and more likely given that your symptoms were better for 4 years) is that you are having sinus infections in one of the sinuses that was not ballooned. You can't balloon the ethmoid sinuses, and your surgeon may have only ballooned the affected sinuses. For instance say he ballooned both your frontal sinuses, but on the scan your maxillary sinuses looked normal, so he didn't balloon your maxillary sinuses. Now you could develop maxillary sinusitus. Another option is that your ballooned sinuses have scarred down. This is not very common and probably not the cause, but you can't tell without a CT scan. Another option is that you have nasal polyps that were removed during the first case. IF you had nasal polyps removed, they typically grow back. How quickly they recur depends on a lot of factors. But a polyp can block a sinus that was successfully ballooned in the past and has not scarred down, and this blockage will cause a sinus infection. Pretty much the only way to tell what is going on is to see your ENT physician, undergo a nasal endoscopy in clinic and perhaps a CT scan.