I would like to comment on the issues that Birchall raised in his letter:
Patients who were not selected for the study used beclomethasone dipropionate spray as per our routine and have no bearing on the study.
Bronchial asthma is not universal in patients with nasal polyposis (8%-40%).1,2 The patients who were receiving treatment for bronchial asthma were excluded. Similarly, patients with mucoviscidosis and Kartagener syndrome (5 such patients were encountered during the study period) were excluded.
I prescribe local steroids to all patients following endoscopic sinus surgery for nasal polyposis. Therefore, there is no preoperative bias in the population receiving steroids.
Postoperative steroid spray should not begin before full epithelialization of the cavity to prevent damage to the regenerating mucosa. Once the cavity is epithelialized without crustations, this is the starting time for observation and not the time of surgery.
The only variable
Mostafa BE. Fluticasone-Reply. Arch Otolaryngol Head Neck Surg. 1997;123(4):450. doi:10.1001/archotol.1997.01900040101018