Based on several recent evidence-based guidelines, sinonasal 'surgery' can be considered for patients with medically refractory CRS as defined by having persistent symptoms despite a minimum of 3 months with topical sinonasal corticosteroid therapy along with a minimum of a 7-day course of systemic corticosteroid +/- 2-week course of broad-spectrum antibiotic. The important question remains, what is the most appropriate surgical intervention for patients with refractory CRS? Currently there are two surgical options for CRS and both procedures have non-randomized evidence to support their beneficial effects in this patient population: (1) Septoplasty alone (ie. only correcting the deviated septum and not dissecting into the paranasal sinuses), and (2) Endoscopic sinus surgery (ESS) along with a septoplasty (ie. correcting the septal deviation and opening up the paranasal sinuses). With an estimated direct health care cost exceeding $100 million spent on sinonasal surgery in Canada for management of CRS, optimizing the allocation of scarce surgical resources toward interventions with the most proven benefit would result in significant improvements in both the quality and value of care to patients.