I have been successfully using fluticasone propionate for some years in my patients with sinusitis, both before and after nasal surgery, including endoscopic polypectomy. It was therefore with some anxiety that I read the startling title of the article by Mostafa in the Archives.1 This changed to bewilderment when I read the contents.
The patients were selected preoperatively and non-consecutively. What of those not selected? How were asthma (often undiagnosed in these patients) and mucociliary clearance abnormalities (almost universal in these patients) excluded? The randomization method described, including several levels of matching, is obscure and improbable. The study is not blinded for either the patients, who were told that there was something different about fluticasone, or the operating surgeon, who was presumably the author.
The biggest flaw, however, is that randomization was performed preoperatively. The population given the nasal spray would have a completely different profile on computed tomography,
Birchall MA. Fluticasone. Arch Otolaryngol Head Neck Surg. 1997;123(4):449–450. doi:10.1001/archotol.1997.01900040101017
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