The middle meatus is the site of abnormalities which are to a great extent responsible for naso-sinus pathology. Its exploration has benefited from improvements in optical systems (microscopes and endoscopes) and radiological investigations. We present our experience with exploration and surgery of the middle meatus under endoscopic control. The medical examination (past history, allergy, etc.) combined with radio-endoscopic findings helps to define the appropriate therapy. Functional surgery is sometimes necessary. This is performed under local anesthetic, which in our experience improves the condition for the procedure and decreases the post-operative complications.