Middle ear surgery and otologic procedures including ossiculoplasty, stapedectomy and labyrinthectomy are done with great finesse with the help of delicate microsurgical instruments. The objective is to restore function of the ear. The microscope offers illumination and magnified visualisation. It is therefore very surprising that this expert microotologist often prefers to perform gross ethmoidal surgery with Luc's forceps and head light. One can practice the same finesse for nasal surgery using Functional Endoscopic Sinus Surgery (FESS); after all, there is so much of similarity between the middle ear cleft and sinonasal complex. The nasopharynx via the eustachian tube extends into the middle ear and mastoid while the nose extends into the paranasals sinuses. Thes~ are like two siblings who have parted ways and have started two families the otologists and the rhinologists. As far as pathophysiology is concerned, the middle ear is aerated through the eustachian tube, blocking of which results in the disease of the middle ear cleft. The paranasal sinuses are aerated through their natural ostia which open in the middle meatus or spenoethmoidal recess. Any block here results in sinusitis. Cholesteatoma, though a benign disease, has a tendency to go into intracranial complications. Similarly sinonasal polyposis can invade the orbit and even the cranium. Looking at the anatomical configuration of the mastoid, there is a large antral cell surrounded by labyrinthine, retrofacial, perisinus, sinodurat, zygomatic, peritubal, petrous and tip cells. In the ethmoid labyrinth there is the bulla ethmoidalis around which are anterior, middle and posterior ethmoid cells with the occasional Onodi cell, Hailer cell and even septal cells. The supratubal recess and sinus tympani may be compared to the supraorbital recess and sinus lateralis respectively. In the ear, there is the facial nerve, while in the sphenoid and posterior ethmoid sinus, there is the optic nerve. Occasionally both could be dehiscent and lying bare.