It is an interesting concept to assess how much impact the presence of a large concha bullosa (CB) has on both severity of chronic rhinosinusitis (CRS) and also postoperative outcomes after FESS. The authors accept that the paper has limitations as this is a retrospective review of notes and a future prospective study would be useful, and they were not able to take into account the impact of septal deviations in the same cohort. I found several observations interesting. Firstly, “patients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal rhinological scores at baseline, but also report greater improvement following ESS.” Secondly, Lund-Mackay CT scores were generally lower for patients with CB. When the two data sets were compared, there was a trend for patients with a CB and lower Lund-Mackay scores to also have a higher SNOT-22 scores, “suggesting that a large CB may be associated with worse symptoms than objective radiographic disease burden would suggest” (though this was not a statistically significant finding). This paper certainly suggests that in the presence of a large CB in a patient undergoing FESS, it is worthwhile addressing the CB at the same time as the sinuses.