In 2005, a prospective non-randomized study compared septoplasty alone to septoplasty plus ESS. They demonstrated that septoplasty alone had a 93% subjective success rate for patients with CRS which was no different than the 88% success rate of ESS plus septoplasty. Although this study has provided some insight into this topic, it was limited by the lack of randomization, lack of stringent inclusion criteria for refractory CRS, and lack of using a validated patient-reported outcome measure. Since 2004, there have been several prospective observational cohort studies evaluating the role of ESS in patients with refractory CRS. Overall the outcomes from these studies suggest that ESS provides improved patient-reported outcomes and objective outcomes. However, despite excellent observational evidence supporting both septoplasty and ESS, there has never been a robust randomized controlled trial (RCT) to prove additional benefit of ESS compared to septoplasty alone for patients with CRS.