<p>Thanks to our predecessors and technical progress, we can nowadays offer our patients a safe and modern paranasal sinus surgery. This article provides an overview of the historical development of paranasal sinus surgery in Austria and Switzerland and to shed light on the dynamic progress of this discipline in an international context. Paranasal sinus surgery has undergone significant change in recent decades, driven by rapid technological advances that have significantly improved surgical procedures and operative outcomes. While indications were originally limited to treatment of inflammatory diseases, today, endoscopic procedures cover interventions in the area of the anterior skull base, the orbit and sinonasal tumors. The concept of functional endoscopic sinus surgery (FESS) may seem simple, but the anatomic variability, especially in the area of the frontal sinus, as well as the wide spectrum and severity of diseases can be a&#xa0;challenge. Therefore, paranasal sinus surgery should not be a&#xa0;casual operation and should only be performed by well-trained surgeons to prevent disease recurrence as well as medical and economic follow-up costs. Standardized surgical training for aspiring paranasal sinus and skull base surgeons is critical. Preoperative planning through systematic analysis of CT images is an essential factor to achieve optimal results and to avoid intraoperative complications. The pathophysiological understanding of sinonasal disease and the recent developments of new drug therapies such as monoclonal antibodies also enable excellent results in the small subgroup of patients who do not benefit from a&#xa0;combination of surgical rehabilitation and long-term drug therapy. The dynamic development of endoscopic paranasal sinus surgery in recent decades shows the potential of the field for the coming decades.</p>