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Introduction: Chronic rhinosinusitis (CRS) and asthma frequently coexhist in children leading to the unified airway theory. Although obesity has been associated with CRS and asthma in adults, studies exploring that association in children are limited. The goal of this study was to evaluate the association between obesity and the unified airway in children. Methods: A retrospective case-control study was performed in children aged 2 to 18 years presenting to our clinic between July 2020 and February 2024. Patient's demographics and comorbidities were reviewed. Children's obesity was classified based on their percentile body mass index of 95% and more. Asthma and CRS diagnoses were determined based on published guidelines. Results: A total of 406 pediatric patients met criteria, with 130 children (32%) with obesity. Children with CRS had a mean computed tomography (CT) Lund-Mackay score of 7.2 (SD of 6.3) and a mean endoscopy modified Lund-Kennedy score of 2.7 (SD of 2.9). Children with obesity were older (11.3 years vs 10.2 years, P = .039) and more likely to have asthma (28.5% vs 15.2%, P = .002) and obstructive sleep apnea (26.2% vs 13%, P = .001). Multivariate logistic regression showed an association between obesity and asthma (OR = 1.84, P = .029), but not with CRS (OR = 1.08, P = .856) or allergic rhinitis (OR = 1.05, P = .856). Conclusion: This study suggests an association between obesity and asthma but not with CRS in children. Further studies should explore whether there is any role for obesity in the treatment of CRS., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.