Maxillary sinusitis is a common problem presenting in the ENT OPD. Traditionally plain radiography in the form of Water's view is in vogue to diagnose sinusitis. This study aimed to determine the reliability of Water's view in the initial management of chronic maxillary sinusitis. Methodology: This study was conducted at ENT Department, Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar from January 1, 2008 to June 30 2009. A total of 120 cases were included in the study after

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... tailed history taking and clinical examination. All the patients underwent sinus radiography (Water's view) and antral lavage. A correlation of radiographic with antral lavage findings was made. Results: All the cases had radiological evidence of maxillary sinusitis. The radiological findings on sinus radiography were; Opacification (40.83%), Mucosal thickening (23.33%), Haziness (19.16%) and Air fluid levels (16.66%). The antral lavage was positive in: Air fluid levels: 100%, Opacification: 81%, Haziness: 61%, and Mucosal thickening 39%. On the whole, there was a 71% positive correlation of sinus radiography with antral lavage in the study. Conclusion: The presence of air fluid levels and sinus opacification on plain radiography are more reliable evidences of maxillary sinusitis as compared to haziness and mucosal thickening. Water's view of the paranasal sinuses gives important information regarding maxillary sinus pathology but it should be interpreted in the light of history and clinical findings.