Objective This study was designed to determine whether smoking patients have poorer outcomes after endoscopic sinus surgery (ESS) based on a reliable validated rhinosinusitis‐specific quality‐of‐life outcomes test. Study Design Retrospective chart and computed tomography (CT) review with telephone and letter questionnaire. Methods Charts of 230 adult patients undergoing ESS for chronic rhinosinusitis between January 1995 and December 1998 were reviewed. Each participating patient completed a detailed questionnaire, including the Sino‐Nasal Outcome Test‐16 (SNOT‐16), at an average of 52 months after surgery. Preoperative CT scans were reviewed and the findings used to stage the patients' conditions. Multivariate analysis was used to assess these data. Results Eighty‐two patients completed the questionnaire, with 26 who smoked at the time of surgery and continued to smoke at the time of answering the questionnaire (Smokers). Average SNOT‐16 score in Smokers was 27.5, versus 18.2 in those who did not smoke at the time of surgery (Non‐Smokers). There was a statistically significant correlation between elevated SNOT‐16 scores and smoking (P < .001) and antibiotic use within the past year (P < .001). There was an association between high SNOT‐16 scores and both prior smoking and passive smoke exposure that did not reach statistical significance (P = .055 and P = .267, respectively). CT staging scores and prior ESS were not statistically correlated with SNOT‐16 scores. Conclusions Smoking is associated with statistically worse outcomes after ESS based on average SNOT‐16 scores. Although no investigator has proved that the effects of smoking on sinonasal health are reversible, we counsel smoking patients considering ESS about the desirability of smoking cessation (for this and many health reasons), and the possibility of a poorer postsurgery outcome should they continue smoking.