Surgical modalities such as tonsillectomy and/or adenoidectomy, antral irrigations, and inferior meatal windows have not been effective in treating most cases of chronic sinusitis. Recent advances in technology have allowed a more direct approach to the obstruction and diseased tissue. The ethmoid sinus can now be approached directly and safely. The natural ostium to the maxillary sinus can be enlarged endoscopically with a high degree of patency. Techniques have been developed that limit the amount of scarring, and the procedure can be performed safely. The endoscopic ethmoidectomy and maxillary antrostomy has provided our best surgical modality for the treatment of chronic sinusitis in children to date.