<p>Several different surgical techniques have been tried in the handling of nasal obstruction due to posterior nasal septal deviation and septal spur. This study aims to compare the outcomes of endoscopic versus conventional septoplasty (CS) for management of such issue. A retrospective randomized study was conducted on 112 individuals who had exclusive septoplasty and had either a posterior septal deviation or a septal spur. While 53 underwent endoscopic surgery (ES), 59 of them received conventional approach. The two groups were compared regarding the preoperative clinical presentation, intraoperative characteristics (duration of surgery, blood loss, nasal packing, and septal flap tear), early postoperative care (bleeding and pain), and complications three months after surgery such as synechia, numbness, septal perforation, incomplete correction, and septal hematoma. Subjective measurements (Nasal Obstruction Symptom Evaluation [NOSE] and pain scale) were used in the evaluation. Duration of surgery, intraoperative blood loss, and number of patients with nasal packing were significantly lower in ES (<i>p</i> &lt; 0.001). NOSE score and pain scale were significantly lower in ES (<i>p</i> &lt; 0.001). Postoperative numbness was significantly lower in ES (<i>p</i> &lt; 0.001). Complications such as synechia, septal perforation, incomplete correction and septal hematoma were lower in ES with no statistical significance (<i>p</i> = 0.168, 0.245, 0.161, 0.497 respectively). With ES, septal spurs and posterior septal deviations are easier to treat with less duration of surgery and less blood loss. ES resulted in higher patient satisfaction regarding pain and an improvement of nasal obstruction. The complications associated with ES are lower.</p>