Endoscopic sinus surgery (ESS) is the mainstay of treatment for patients with chronic rhinosinusitis (CRS) who fail medical therapy. Success rates are as high as 80-90%, however, all otolaryngologists will recognize patients within their practice with surgically recalcitrant disease. A range of factors can play a part in disease relapse and managing these is critically important when considering revision surgery. In this International Symposium, we aim to provide delegates with advice and guidance in managing this challenging subset of patients though case-based education and panel discussion. The goals of this program are: 1) To provide an overview of factors that influence disease relapse. 2) Advice in how to medically manage patients who fail ESS. 3) To offer a range of surgical tips when planning revision surgery.