To optimize success in sinus surgery, we use a combined macro-micro-endoscopic technique (COMMET). This technique effectively combines use of the headlamp, microscope, and endoscope according to the demands of each anatomical region. Between April 1991 and March 1994, we successfully performed this technique on 461 patients (798 sides). According to CT scans, about 40% of the patients had pansinusitis, and about 30% of the patients had anterior and posterior ethmoiditis combined with inflammation of other sinuses. Hence, severe cases requiring total ethmoidectomy accounted for about 70% of all sides. All patients were operated on under general anesthesia. The objective of this operation was restoration of drainage and ventilation, and then to allow recovery of the reversible mucosal lesions. The goal of surgery was to normalize all paranasal sinuses. In many patients, there is little correlation between postoperative objective findings in the paranasal sinuses and subjective improvement. Therefore, postoperative subjective improvement cannot be used as the criterion for evaluating the improvement of sinus disease. Hence, we established an objective grading system based on CT and endoscopic findings and evaluated improvements in each sinus after drainage and ventilation had been restored. The rates of normalization over 1 year following surgery (mean follow-up time was 19-20 months) were 64% in the frontal sinus, 72% in the anterior ethmoid sinus, 68% in the maxillary sinus, 90% in the posterior ethmoid sinus and 80% in the sphenoid sinus. The results differed from sinus to sinus, suggesting that there are different factors impairing recovery in each sinus.(ABSTRACT TRUNCATED AT 250 WORDS)