With the advent of new endoscopic instruments, rhinologists are reassessing and modifying ethmoidectomy techniques. Despite this renewed interest, the transantral ethmoidectomy has received little attention, even though this procedure has the advantages of avoiding an external incision, safely delineating the medial orbital wall, and simultaneously treating ethmoid and maxillary sinus disease. The present study compared 74 transantral ethmoidectomy procedures and 47 external ethmoidectomy procedures. The two groups of patients were comparable with respect to age and gender. There was no statistical difference between the two groups with regard to blood loss. Complications were less frequent in the transantral group. Of the 97 patients treated for ethmoid sinusitis, outcome was more successful in the transantral group than in the external ethmoidectomy group when assessed by the need for additional medical or surgical treatment.