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smoke. I could not smell anything.(Participant 13, female, CRSwNP) Anterior and posterior nasal drip were also described by patients as a frustrating symptom which also has important consequences on QoL. Some participants also described a sense of social anxiety associated with discharge. Meeting new people came with the inevitability of having to explain they were not contagious; they felt the need to constantly justify why they were blowing their nose, and one patient spent a significant amount of time going to the bathroom to clean his hands because he was afraid of appearing unhygienic. People think it’s trivial. But it is not trivial. Everyone asks: “you still have that?” We have gone to the moon; how come we cannot prevent polyps from coming back?(Participant 15, female, CRSwNP) Symptomatology and disease progression varied widely between participants. That said, the severity of the impact on patients’ quality of life and the general feeling of exasperation and desperation before seeking out surgery was shared among most participants. In other words, patients seemed to elect surgery if they not only had symptoms, but if these symptoms prevented them from living a normal life. Objectives and expectations As previously described, the majority of participants had a tendency to focus on a principal symptom when describing the incapacity associated with CRS. With a lot of their attention often directed towards that symptom; patients’ main objective was often to correct their most bothersome symptom.My objective for surgery was to eliminate the headaches. I wanted them to disappear. And it worked, it really worked. But the relief only lasted 1 year and 2 months.(Participant 21, male, CRSsNP) I chose to undergo surgery because I wanted to be able to breathe and smell like before.Now I can smell, and it has given me my life back.(Participant 22, male, CRSwNP) Other participants described more general objectives. They wanted to improve their condition, get rid of the chronic malaise, improve their QoL, or “become normal”. Patients’ objectives and expectations both appeared inversely proportional to the amount of previous surgeries and the severity of CRS impact. In other words, patients who had only been operated once had a tendency to describe that they hoped for (or expected) a full return to normality after ESS. Patients who had undergone many surgeries had more pessimistic expectations and tended to have less ambitious objectives. Furthermore, some patients with incapacitating constant headaches or a complete incapacity to breathe from the nose stated that any small improvement would be worth going through the ESS. Only a minority of patients (5/22) hoped (or expected) all their symptoms would disappear. Other patients hoped (or expected) and improvement in one symptom in particular, or simply hoped for an improvement in QoL. The first surgery, I did not really have any objectives. The doctor said the polyps were so big, they came out from the nose. The second time I wanted to breath better, I wanted to have less infections and I wanted to have a lasting relief. (Participant 5, male, CRSwNP) My goals were to need less antibiotics and cortisone. Also, I wanted to get rid of my asthma. When I have nasal polyps, my asthma gets out of control.(Participant 15, male, CRSwNP) Criteria for success Among participants, there was a clear association between expectations and satisfaction. Dissatisfied patients tended to have ambitious expectations such as a complete and prolonged cure after ESS. The goal I think is to feel better. I wanted to be 80% better … or at least 60%. I think the goal is also to feel better for as long as possible. Ideally to feel better forever, but by now I don’t really believe anymore that it’s possible. So, I would say at least 4-5 years. (Participant 4, female, CRSwNP) Only one patient reported no improvement whatsoever after ESS, but several participants were not entirely satisfied. This dissatisfaction was often due to a recurrence in symptoms after a while. Patients were asked to determine what decrease in symptom magnitude would make the surgery worth it in terms of risks vs benefits. Their answers ranged from “any noticeable improvement in the main symptom” to “a complete resolution of all symptoms”. The same question was asked for time with symptomatic control. Duration ranged from “1 month” to “forever”Prompt: How long should you be free of symptoms for you to consider the surgery successful?Had you told me 1 month, I would have still gone forth. I could not live like that anymore. Prompt: How much improvement would be necessary for you to consider the surgery successful? Even if it’s not perfect. Even a tiny improvement is worth it. If not for surgery, the only other solution is cortisone. And that is bad for the rest of my body.(Participant 22, male,
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