***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Recent but limited evidence suggests that nasal lavage with hypertonic saline may be useful as an adjunctive treatment modality in the management of pediatric allergic rhinitis . The aim of this study was to clarify whether nasal irrigation with hypertonic solution should be routinely recommended to children with seasonal grass pollen rhinoconjunctivitis . Methods : Fourty-four children with seasonal grass pollen rhinoconjunctivitis were recruited . Twenty-two patients were r and om ized to receive three-times daily nasal rinsing with hypertonic saline during the pollen season , which lasted 7 weeks . Twenty-two patients were allocated to receive no nasal irrigation and were used as controls .  Twenty patients per group completed the study . A mean daily rhinoconjunctivitis score based on the presence of nasal discharge and obstruction as well as ocular symptoms as reddening and itching were calculated for each week of the pollen season . Patients were allowed to use oral antihistamines when required and the mean number of drugs taken per week was also calculated . Results : The mean weekly rhinoconjunctivitis score in the active group was reduced during the whole pollen period . This difference was statistically significant in week 6 and 7 of therapy . A markedly reduced intake of oral antihistamines was also observed in patients allocated to nasal rinsing , being statistically significant in 5 of the 7 weeks . No adverse effect was reported in the active group . Conclusions : This study supports the use of nasal rinsing with hypertonic saline in the pediatric patient with seasonal allergic rhinoconjunctivitis . This treatment proved to be tolerable , inexpensive and effective OBJECTIVE To compare intranasal distribution of saline solution delivered by three popular methods for nasal saline irrigation . STUDY DESIGN Prospect i ve , controlled comparison . METHODS Eight healthy adult volunteers received nasal irrigation with 40 mL of isotonic , nonionic contrast material immediately before having coronal computed tomography to visualize distribution of solution in the paranasal sinuses . For each study subject , three methods of irrigation were used : irrigation using positive-pressure irrigation , irrigation using negative-pressure irrigation , and irrigation using a nebulizer . For each subject , three-dimensional computer reconstructions of the irrigated paranasal sinus airspaces were used to compare contrast solution volume and distribution achieved by the three methods . RESULTS Of the three methods used , two methods , positive-pressure and negative-pressure irrigation , distributed contrast solution widely to ethmoid and maxillary sinuses , but distribution of contrast solution was more uniform using positive-pressure irrigation than using negative-pressure irrigation . The nebulization method distributed contrast solution poorly and result ed in a significantly lower volume of retained contrast solution ( P < .05 ) . CONCLUSION Judged solely on the basis of solution distribution in the nasal sinuses , nasal irrigation is effective when either positive-pressure or negative-pressure irrigation is used but is ineffective when a nebulizer is used BACKGROUND Chronic sinusitis ( CS ) is a common disease in children , especially those with allergies , that is caused by impaired drainage from the sinuses . Hypertonic NaCl solution has been shown to increase mucociliary clearance and ciliary beat frequency . OBJECTIVE We performed a r and omized double blind study to compare the effect of nasal wash with hypertonic saline ( HS ) ( 3.5 % ) versus normal saline ( NS ) ( 0.9 % ) on CS . METHODS Thirty patients with CS aged 3 to 16 years were studied . They were r and omly divided into two treatment groups matched by age and severity of the disease . Each individual was treated with either HS or NS for 4 weeks . All patients were evaluated by two clinical scores ( cough and nasal secretions/postnasal drip [ PND ] ) and by a radiology score at the beginning of the study and after 4 weeks . RESULTS The HS group improved significantly in all scores ( average + /- SD ) : cough score , from 3.6 + /- 0.51 to 1.6 + /- 0.74 ; nasal secretion/PND score , from 2.86 + /- 0.35 to 1.6 + /- 0.74 ; and radiology score , from 8.06 + /- 1.28 to 2.66 + /- 1.04 . The NS treatment group showed significant improvement only in the PND score ( from 2.66 + /- 0.49 to 1.53 + /- 0.83 ) but no significant change in both the cough score ( from 3.53 + /- 0.52 to 3.33 + /- 0.49 ) and the radiology score ( from 8.13 + /- 1.25 to 7.86 + /- 0.91 ) . Clinical observation 1 month after the end of the study showed no change compared with the end of the study in both groups . CONCLUSION HS nasal wash is an efficient treatment of CS OBJECTIVES To test whether daily hypertonic saline nasal irrigation improves sinus symptoms and quality of life and decreases medication use in adult subjects with a history of sinusitis . STUDY DESIGN R and omized controlled trial . Experimental subjects used nasal irrigation daily for 6 months . POPULATION Seventy-six subjects from primary care ( n=70 ) and otolaryngology ( n=6 ) clinics with histories of frequent sinusitis were r and omized to experimental ( n=52 ) and control ( n=24 ) groups . OUTCOMES MEASURED Primary outcome measures included the Medical Outcomes Survey Short Form ( SF-12 ) , the Rhinosinusitis Disability Index ( RSDI ) , and a Single-Item Sinus-Symptom Severity Assessment ( SIA ) ; all 3 were completed at baseline , 1.5 , 3 , and 6 months . Secondary outcomes included daily assessment of compliance and biweekly assessment of symptoms and medication use . At 6 months , subjects reported on side effects , satisfaction with nasal irrigation , and the percentage of change in their sinus-related quality of life . RESULTS No significant baseline differences existed between the 2 groups . Sixty-nine subjects ( 90.8 % ) completed the study .  Compliance averaged 87 % . Experimental group RSDI scores improved from 58.4 -/+ 2.0 to 72.8 -/+ 2.2 ( P < or = .05 ) compared with those of the control group ( from 59.6 -/+ 3.0 to 60.4 -/+ 1.1 ) ; experimental group SIA scores improved from 3.9 -/+ 0.1 to 2.4 -/+ 0.1 ( P < or = .05 ) compared with those of the control group ( from 4.08 -/+ 0.15 to 4.07 -/+ 0.27 ) . The number needed to treat to achieve 10 % improvement on RSDI at 6 months was 2.0 . Experimental subjects reported fewer 2-week periods with sinus-related symptoms ( P < .05 ) , used less antibiotics ( P < .05 ) , and used less nasal spray ( P = .06 ) . On the exit question naire 93 % of experimental subjects reported overall improvement of sinus-related quality of life , and none reported worsening ( P < .001 ) ; on average , experimental subjects reported 57 -/+ 4.5 % improvement . Side effects were minor and infrequent . Satisfaction was high . We found no statistically significant improvement on the SF-12 . CONCLUSIONS Daily hypertonic saline nasal irrigation improves sinus-related quality of life , decreases symptoms , and decreases medication use in patients with frequent sinusitis . Primary care physicians can feel comfortable recommending this therapy A wide variety of nasal irrigation systems are currently available for improving nasal symptoms , but few studies have compared their effectiveness with respect to patient age and type of nasal disease . This pilot study aims to compare the efficacy of two irrigation systems in 20 patients ( 12 males and 8 females ; age range , 19 - 54 years ; mean age , 36 ) with acute rhinosinusitis and treated only with antibiotic ( levofloxacin 500 mg/day for 10 days ) and topical nasal decongestant ( naphazoline 2 puffs in each nostril twice daily for 7 days ) . Patients were r and omly assigned to the treatments , using either a nasal syringe ( 10 mL saline solution , 3 times daily for 14 days ) ( Group 1 ) or the recently available Lavonase system ( 250 mL saline solution sac , twice daily for 14 days ) ( Group 2 ) . Work-up included history , evaluation of signs and symptoms ( nasal obstruction , rhinorrhea ) , nasal endoscopy , and anterior rhinomanometry . Nasal irrigation with the Lavonase system was found to be more effective in reducing symptoms , as all significantly diminished ( p<0.05 ) . In addition , the Lavonase system significantly decreased nasal resistances ( p<0.05 ) . This preliminary study shows that the ancillary treatment of acute rhinosinusitis with Lavonase may be useful Seventy-four children from three weeks to two years of age with various upper respiratory symptoms were r and omly assigned to three groups : two intervention groups ( saline nose drops ; medicated nose drops ) and a control group ( no nose drops ) . Forty-six children returned for check-up two days later . Subjects in all three groups improved between first and second contact . There was no significant difference between the three groups . It is concluded that medicated nose drops are not essential in the treatment of upper respiratory infection and rhinitis OBJECTIVE To evaluate the efficacy of the atomized nasal douche in the restoration of physiological nasal functions in patients affected by acute viral rhinosinusitis , when compared with nasal lavages with isotonic sodium chloride solution . DESIGN R and omized clinical trial . SETTING The ENT Department at the University of Siena Medical School . PATIENTS Two hundred patients affected by acute viral rhinosinusitis were included in the study . INTERVENTIONS Patients were r and omly divided into 2 groups : group 1 patients received an atomized nasal douche , and group 2 patients received nasal lavages with isotonic sodium chloride solution . Patients underwent treatments 4 times per day for 15 days in our institution under our direct control . RESULTS Atomized nasal douches significantly improved inspiratory and expiratory rhinomanometric resistance ( P<.01 ) and nasal volumes measured by acoustic rhinometry ( P<.001 ) . Nasal lavages were unable to modify these variables significantly ( P<.3 ) . Only atomized nasal douches were able to normalize mucociliary transport time to a physiological level ( P<.001 ) . CONCLUSIONS The atomized nasal douche demonstrated a better efficacy than traditional nasal lavages with isotonic sodium chloride solution in restoring all the physiological nasal functions . For this reason , and considering ease of use , painlessness , cheapness , and manageability of the instrument , we suggest the use of the compressor-micronizer chamber system ( Rinoflow Nasal Wash & Sinus System ) as a routine adjuvant to every treatment of acute rhinopathies Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases . However , no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient . Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study . Ten children were r and omized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season , which had lasted 6 weeks . Ten patients were allocated to receive no nasal irrigation and were used as controls . A mean daily rhinitis score based on the presence of nasal itching , rhinorrea , nasal obstruction and sneezing was calculated for each week of the pollen season . Moreover , patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated . In patients allocated to nasal irrigation , the mean daily rhinitis score was reduced during 5 weeks of the study period . This reduction was statistically significantly different in the 3th , 4th and 5th week of therapy . Moreover , a decreased consumption of oral antihistamines was observed in these patients . This effect became evident after the second week of treatment and result ed in statistically significant differences during the 3th , 4th and 6th week . This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season . This treatment was tolerable , inexpensive and effective OBJECTIVE To evaluate the potential of nasal isotonic saline application to prevent reappearance of cold and flu in children during the winter . DESIGN Prospect i ve , multicenter , parallel-group , open , and r and omized comparison . SETTING Eight pediatric outpatient clinics . PATIENTS A total of 401 children ( aged 6 - 10 years ) with uncomplicated cold or flu . INTERVENTIONS We r and omly assigned patients to 2 treatment groups , one with just st and ard medication , the other with nasal wash with a modified seawater solution ( Physiomer ) plus st and ard medication , and observed them for 12 weeks . MAIN OUTCOME MEASURES The primary efficacy end points were nasal symptoms resolution during acute illness ( visits 1 and 2 ) . We also looked for reappearance of cold or flu , consumption of medication , complications , days off school , and reported days of illness during the following weeks when preventive potential was evaluated ( visits 3 and 4 ) . RESULTS At visit 2 , patients in the saline 
    Output:
    
All large medical associations and the authors of systematic review s consistently conclude that SNI is a useful addition for treating CRS symptoms .
The results of systematic review s and medical associations ’ recommendations show the existing but limited efficacy of SNI  in ARS .