The objective of the present work was to substantiate the rational otorhinolaryngological strategy for the treatment of the severe form of combined head injuries with the damage to the nasal sinuses. The theoretical support of the study was provided by the use of such methods as analysis and synthesis, generalization and comparison. The practical methods included the general clinical studies, tests for the functional state of the intranasal mucous membrane, evaluation of motor activity of ciliated epithelium and microbiological techniques. A total of 42 patients with a combined head injury were examined. Congestive processes in the system of nasal sinuses were shown to develop as early as the onset of artificial lung ventilation even in the absence of an injury to the paranasal sinuses. The functional activity of ciliated epithelium was compromised since the first day of artificial lung ventilation and continued to worsen with time. The restoration of the nasal breathing promoted the creation of conditions for the recovery of the functional activity of ciliated epithelium. The secondary site of infection in the nasal sinuses formed on days 3-5.