BACKGROUND : Complete removal of some maxillary sinus pathologies may be challenging. We describe our experience in performing endoscopic inferior meatal antrostomy (EIMA) when approaching certain chronic maxillary sinus disease. METHODS : Retrospectively reviewing charts of all patients whose surgery included EIMA between the years 2012 and 2015. EIMA was performed either after routine endoscopic middle meatal antrostomy (EMMA) failed to completely resect the lesion, or as the sole selected approach for specific maxillary pathologies. RESULTS : A total of 56 patients were included in the study. Indications for EIMA included antrochoanal polyps (ACP), maxillary sinus chronic inflammatory disease, maxillary sinus pathology before sinus lift, and odontogenic maxillary sinusitis. In nearly one third of the patients, sinus surgery included only EIMA, of which, the majority were resection of ACP. Follow-up time ranged between 12 and 34 months (mean 14). Residual EIMA opening was variable in size. In the vast majority of our patients, the maxillary sinus cavities were cleared of disease. No major complications and no recirculation were observed in any of the patients. CONCLUSIONS : EIMA should be considered for various maxillary sinus pathologies. It provides better access to anteroinferior lesions of the maxillary sinus. EMMA is not mandatory for every maxillary sinus disease.