Inverted papilloma (IP) is histologically a benign disease, but it has long been recognised as warranting aggressive surgical management. It has a propensity to be locally destructive, has high rates of recurrence, and a strong association with malignant transformation. Aetiology of IP is still uncertain, but Human Papilloma Virus (HPV) is implicated and, in a similar manner to cervical HPV infection, is proposed to have a role in malignant change occurring within IP. A review of recent literature on the aetiology of IP and possible predictors of recurrence and malignant potential is presented. Krouse’s staging of IP is discussed, with a recently published modification, adjusted for prognostic factors. Results of endoscopic and open surgery, with long-term follow-up are reviewed.