Aims Airway management in rhinological surgery varies internationally. In many European countries, endotracheal intubation (ETT) remains standard for sinonasal procedures, while in Australia, the laryngeal mask airway (LMA) is widely adopted. This study compares the safety and efficacy of both techniques, focusing on airway protection and postoperative bleeding, and explores whether differing practices reflect evidence or tradition. Methodology A comprehensive review of the medical literature was conducted. These studies compared intraoperative and postoperative outcomes of LMA and ETT in various rhinological surgeries. Key parameters evaluated included the incidence of postoperative bleeding, airway protection, cardiovascular stability, and pharyngolaryngeal symptoms. Results The use of LMA in rhinological surgeries is associated with reduced airway stimulation, smoother emergence from anesthesia, and fewer postoperative complications such as sore throat and coughing. Studies have shown that LMA can provide adequate airway protection and is associated with a lower incidence of cardiovascular lability compared to ETT. However, LMA may be associated with a higher risk of postoperative nasal bleeding outside the operating room. In contrast, ETT offers superior airway protection, reducing the risk of aspiration and airway contamination during surgeries with significant bleeding risks. ETT is associated with higher incidences of postoperative sore throat, hoarseness, and coughing. Conclusion While LMA offers advantages in terms of reduced airway irritation and faster recovery times, ETT provides better protection against significant bleeding risks. The choice between LMA and ETT should be based on the specific surgical context and patient risk factors. The contrast between European and Australian practice highlights how local culture and experience shape airway choice. This presentation proposes a practical decision algorithm for selecting the optimal airway in intranasal surgery.