Technological advances in video imaging over the last decade have resulted in remarkable additions to the armamentarium of instrumentation for the otolaryngologist. The use of video cameras and computer generated imaging in the operating room and office is invaluable for documentation and teaching purposes. Despite the obvious advantages of these systems, problems are evident, the most serious of which include image distortion and inability to judge depth of field. For more than 6 decades 3D imaging has been neither technically nor commercially successful. Reasons include alignment difficulties and image distortion. The result is “visual fatigue,” usually in about 15 minutes. At its extreme, this may be characterized by headache, nausea, and even vomiting. In this study, we employed the first 3D video imager to electronically manipulate a single video source to produce 3D images; therefore, neither alignment nor image distortions were produced. Of interest to the clinical surgeon, “visual fatigue” does not seem to occur; however, with prolonged procedures (greater than 2 hours) there exists the potential for physical intolerance for some individuals. This is the first unit that is compatible with any rigid or flexible videoendoscopic system and the small diameter endoscopes available for endoscopic sinus surgery. Moreover, prerecorded 2D tapes may be viewed in 3D on an existing VCR. The 3D image seems to provide enhanced anatomic awareness with less image distortion. We have found this system to be optically superior to the 2D video imagers currently available.