When medical management fails to control the symptoms of chronic sinusitis, surgical intervention is frequently considered. The more commonly recommended procedures include tonsilectomy and adenoidectomy, adenoidectomy alone, maxillary sinus irrigation, and nasal antral windows. These procedures have not undergone meticulous prospective evaluation or documentation of chronic sinusitis. It has only recently become known that plain sinus x-ray films are frequently misleading, and there has been a tendency to completely ignore ethmoid disease. Adenoidectomy has been frequently recommended; however, these studies have not documented the duration of symptoms or the extent of disease. Approximately 20% of the patients treated with tonsilectomy and adenoidectomy do not have resolution of symptoms of chronic sinusitis. It is prudent, however, to remove an enlarged obstructive adenoid pad as a first course of therapy. Irrigation has been proposed, but it treats only the maxillary sinus, and the ethmoid sinuses are involved approximately 70% of the time. One irrigation rarely clears the symptoms. Nasal antral windows in children require well-developed maxillary sinuses and do not maintain their patency. Therefore they are not an effective mechanism for treating chronic sinusitis. Other surgical modalities must therefore be sought.