***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 Background This study was design ed to determine if the addition of large-volume , low – positive pressure nasal irrigations delivered with isotonic sodium chloride ( hereinafter “ saline ” ) added to intranasal corticosteroid therapy improves quality of life and objective measures of nasal breathing in patients with allergic rhinitis when compared with intranasal corticosteroid alone . Methods A prospect i ve , unblinded , single-arm pilot study was performed of patients with allergic rhinitis already on intranasal corticosteroid pharmacotherapy . Patients added large-volume low-pressure saline irrigation twice daily for 8 weeks to their ongoing regiment of nasal corticosteroid .  Mini-Rhinoconjunctivitis Quality of life Question naire ( mRQLQ ) assessment and nasal peak inspiratory flow ( NPIF ) were performed at baseline and at 4 and 8 weeks . Results A total of 40 patients were enrolled . Twice-daily nasal irrigation with isotonic saline significantly < 0.001 ) red d mRQLQ scores , from 36.7 ± 20.48 ( baseline ) to 14.9 ± 11.03 ( 4 weeks ) to 10.10 ± 10.65 ( 8 weeks ) . No significant changes were seen in NPIF , pattern use of nasal steroid use , or adverse events . Conclusion Large-volume , low – positive pressure nasal irrigation with isotonic saline is an effective adjunctive therapy to improve quality of life in patients with allergic rhinitis already on intranasal corticosteroid therapy . This study was a part of the clinical trial NCT01030146 registered at clinical trials.gov STUDY OBJECTIVE Local nasal hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various rhinitis disorders such as the common cold and allergic rhinitis .  Inhaled heated vapor treatments and simple saline solution nasal irrigation were investigated for their effect on inflammatory mediator production in nasal secretions . DESIGN Three treatments were given for nasal irrigation : heated water particles ( large particle water vapor ) at 43 degrees C , heated molecular water vapor ( molecular water vapor ) at 41 degrees C , and simple saline solution nasal irrigation . Nasal washes were done before each treatment ( baseline ) , immediately after treatments , and at 30 min , 2 , 4 , and 6 h. Histamine , prostagl and in D2 , and leukotriene C4 ( LTC4 ) concentrations were measured in nasal secretions and compared with baseline values . PATIENTS AND PARTICIPANTS Thirty symptomatic patients with active perennial allergic rhinitis underwent three treatments at weekly intervals . MEASUREMENTS AND RESULTS Nasal histamine concentrations fell substantially with the nasal irrigation ( p < 0.01 immediately posttreatment and at 30 min ; p < 0.05 at 2 , 4 , and 6 h ) . Large particle vapor also reduced histamine concentrations for up to 4 h posttreatment compared with baseline values ( p < 0.05 ) . Alternatively , molecular water vapor did not alter nasal histamine concentrations . Surprisingly , the three treatments did not alter prostagl and in D2 concentrations over the 6 h. Leukotriene C4 concentrations fell briefly after the large particle treatment but did not with the molecular water vapor . With saline solution irrigation , LTC4 concentrations in nasal secretions were lower than baseline at 30 min to 4 h after a treatment ( p < 0.05 ) . CONCLUSIONS This study demonstrated the usefulness of large particle vapor treatment and saline solution irrigation in reducing inflammatory mediators in nasal secretions and indirectly supports the clinical efficacy of these treatments for chronic rhinitis BACKGROUND Nasal irrigation has been used as an adjunctive therapy of allergic rhinitis ( AR ) . Available evidence suggested that buffered hypertonic saline ( BHS ) is superior to buffer normal saline ( BNS ) for relief nasal symptoms . OBJECTIVE To evaluate the effectiveness of BHS nasal irrigation in the management of children with symptomatic AR . DESIGN This was a r and omized , prospect i ve , double-blind placebo-controlled study . METHODS The present study was a r and omized prospect i ve double-blind placebo-controlled study . Eighty-one children with symptomatic AR who had a total nasal symptom score (TNSS)≥4 were included in this study . Each participant was r and omly treated with either normal saline ( NSS ) or BHS by a blinded investigator . Nasal saccharine clearance time ( SCT ) and TNSS were measured before and 10 min after nasal irrigation . Quality of life ( QoL ) was assessed using the question naire for Thai allergic rhinoconjunctivitis patients ( Rcq-36 ) . The 7-point Likert scale for satisfaction was also performed . All participants were assigned to perform nasal irrigation twice daily for the period of 4 weeks . During this period , they recorded TNSS , side effects and antihistamine use on daily diary card . A physical examination and subjective evaluation were performed at 2nd and 4th week visits , and daily diary cards were collected . RESULTS Patients with BHS were significantly improved in SCT ( 39.2 % versus 15.5 % , P=0.009 ) and TNSS ( 82.7 % versus 69.3 % , P=0.006 ) compared to the NSS group . However , at 2nd and 4th week both groups had improvement in TNSS and QoL compared to baseline visit . There was a significant improvement in mean QoL score in BHS group at 2nd week visit compared to NSS group ( P=0.04 ) but not at the 4th week . Nasal congestion but not TNSS was significantly improved in the BHS group ( P=0.04 ) . Moreover , a decreased use of oral antihistamine was observed in BHS group ( P=0.04 ) . There were few complaints reported , and side effects were seen equally in both groups . CONCLUSION Nasal irrigation with BHS causes an improvement in SCT , TNSS and QoL compare to NS in children with symptomatic AR 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 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 
    Output:
    
Subgroup analysis showed the improvement in both adults and children .