Sinonasal tumours are rare and histologically diverse. They present with non-specific symptoms and are often advanced at the time of diagnosis. There is limited high-level evidence for their work-up and management. Most tumours are assessed endoscopically, imaged with both contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI), and undergo biopsy prior to treatment; surgery and postoperative radiotherapy are the mainstay. Over recent years, there have been significant advances in endoscopic surgical techniques. Despite advances in management, overall survival for most tumour types continues to be poor. Imaging plays an important role in staging tumours, planning the surgical approach, assessing the response to treatment, and monitoring for recurrence and distant disease. CT is better for assessing bone destruction, whereas MRI is better for assessing the extent of the tumour, perineural spread, and intracranial and orbital involvement. Ultrasound is a useful tool for assessing cervical lymph nodes and for guiding fine needle aspiration cytology. Positron-emission tomography CT (PET-CT) may be helpful in the post-treatment setting to identify recurrence. Baseline MRI should be acquired 3–4 months after treatment and then at regular intervals. Some tumours, such as olfactory neuroblastoma, should be imaged for life because of their propensity to recur many years later.