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Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract Introduction Chronic rhinosinusitis (CRS) is characterized by inflammation of the nose and paranasal sinuses. Its diagnosis is incumbent upon both subjective complaints and objective findings (endoscopy or CT scan). The EPOS 2012 Position Paper on Rhinosinusitis and Nasal Polyps defines CRS as two or more of the following symptoms for at least 12 weeks: nasal blockage/congestion/obstruction, nasal discharge, facial pain/pressure, hyposmia/anosmia (with the presence of at least either nasal blockage, congestion, obstruction or nasal discharge) [1]. These rhinologic symptoms are often an important burden on patients’ quality of life (QoL). Beyond these symptoms, multiple studies link CRS with sleep disturbances, fatigue, depression, anxiety and an overall decrease in quality of life [2,3,4,5]. While rhinologic symptoms are sufficient for the clinical diagnosis of CRS, non-rhinologic complaints remain an important part of the clinical portrait. A recent study has shown that patients with depression have an increased sino-nasal disease burden and pain compared to non-depressed patients. In fact, surgical outcomes appear less favorable in the former group [6]. A thorough understanding of patients’ perspectives and experiences with CRS and endoscopic sinus surgery (ESS) is likely to favor patient-physician collaboration and improve shared decision-making. The Quality Improvement Committee of the American Rhinologic Society identified CRS as a priority in the development of quality measures for rhinologic diseases [7]. One significant obstacle in all aspects of the management of CRS remains the ability to have universal,
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