Endoscopic sinus surgery has progressed from a limited surgical interv
ention for chronic sinus disease to a viable approach for diffuse sino
nasal polyposis, benign tumors, skull base defects, and orbital lesion
s. Some aspects of endoscopic diagnosis and treat: ment, however, rema
in controversial and are poorly understood. Controversies in endoscopi
c sinus surgery are reviewed and the primary critical issues with rega
rd to the more recently developed instrumentation and the newer extend
ed approaches are presented.