<p>Allergic fungal rhinosinusitis (AFRS) is a common disease with a high rate of recurrence. Endoscopic sinus surgery (ESS), postoperative systematic and local medications are the cornerstone of AFRS management. The optimal postoperative medical regimen is still controversial. High volume saline and steroid sinus irrigation appear to improve nasal symptoms and reduce recurrence after ESS. Manuka honey sinus irrigation offers several advantages over traditional topical medications as it possesses antibacterial, antifungal and anti-inflammatory characteristics. The aim of this study is to investigate whether adding Manuka honey to the standard saline and steroid sinus irrigation will improve postoperative results in management of AFRS. In this two-arm prospective, randomized single blind study, thirty patients diagnosed with AFRS were recruited after ESS. Patients randomly received high volume hypertonic saline and steroid (Budesonide 0.5&#xa0;mg/2 mL in 240 mL saline) sinus irrigation alone (group A) and combined saline-steroid and Manuka honey sinus irrigation (group B) twice daily for 12 weeks postoperatively. Both cohorts were monitored for six months postoperatively. Lund-Kennedy endoscopic scores (<i>P</i> = 0.029), total IgE levels (<i>P</i> = 0.021) and the SNOT-22 scores (<i>P</i> &lt; 0.001), were significantly improved in group B after the added Manuka honey sinus irrigation. Both groups had similar Lund-Mackay radiological scores and numbers of postoperative sinus infections during follow up period. Postoperative Manuka honey as an add-on therapy to saline and steroid sinus irrigation is more effective than the sole use of saline-steroid irrigation for reducing symptoms and preventing recurrence of AFRS.</p>