The article by Dr Thaler emphasizes part of the perioperative management of an often difficult group of patients. In the preoperative period, the surgeon and patient exchange information so that informed consent and alignment of expectations occur. All ESS procedures are assumed to be anatomically perfect, but in reality there are often aspects in which one area or another is in doubt. The ability to check the frontal sinus opening or an area in the lateral posterior ethmoid is important in many patients, especially those in whom nuisance bleeding may have been more than usual.