***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 Topical glucocorticoids are the medical treatment of choice in a majority of patients suffering from nasal polyposis .  Fluticasone propionate is a fluorinated steroid reported to be highly effective when used topically in the nose for seasonal and perennial allergic and nonallergic rhinitis . OBJECTIVES To evaluate the efficacy and tolerability of intranasal fluticasone propionate in the treatment of long-st and ing polyposis . METHODS Fifty-five patients with long-st and ing nasal polyposis were treated over a 26-week period with fluticasone propionate aqueous nasal spray 200 micrograms bid , beclomethasone dipropionate aqueous nasal spray 200 micrograms bid or placebo , administered intranasally in an aqueous spray in a double-blind , placebo-controlled parallel-group design at a single center . The primary efficacy endpoint was the physicians ' assessment of symptoms and polyp score . Peak nasal inspiratory flow was performed twice daily and on every visit to evaluate the effect of the corticosteroids on nasal air flow . RESULTS A significant difference in the primary efficacy endpoint between fluticasone propionate aqueous nasal spray and beclomethasone dipropionate aqueous nasal spray compared with placebo was seen after 14 weeks of treatment . This was further verified by the peak nasal inspiratory flow results . There was some evidence of earlier onset in the fluticasone propionate aqueous nasal spray group compared with the beclomethasone dipropionate aqueous nasal spray group after 4 weeks in terms of the primary efficacy endpoint . From the daily record cards patients receiving fluticasone propionate aqueous nasal spray had a significantly higher percentage of days on which they required no rescue medication ( P < .009 ) and a higher percentage of days with an overall nasal blockage score on waking of < 2 ( P < .013 ) when compared with placebo-treated patients . No other statistically significant results were found between the two active compounds . CONCLUSION Fluticasone propionate aqueous nasal spray 200 micrograms bid and beclomethasone dipropionate aqueous nasal spray 200 micrograms bid are effective in treating the symptoms of nasal polyps , with some evidence that fluticasone propionate aqueous nasal spray has a faster onset of action and is tolerated at least as well as beclomethasone dipropionate aqueous nasal spray at the same dose BACKGROUND : Topical nasal steroids such as beclomethasone dipropionate and fluticasone propionate have been widely used in the treatment of rhinitis and polyposis . An increase in infection has occurred with the use of fluticasone propionate after endoscopic polypectomy . OBJECTIVE : The purpose of this study was to determine the prevalence of nasal and paranasal infections with the use of topic nasal steroids after endoscopic polypectomy and to compare the recurrence rates of the polyposis . DESIGN AND SETTING : We conducted a prospect i ve , comparative , open , experimental , longitudinal study at an academic tertiary referral medical center . METHODS : One hundred sixty-two patients in whom endoscopic polypectomy had been indicated were r and omly divided into 3 groups of 54 patients each . The patients from the first group were treated with saline lavage only . Patients from the second group also received fluticasone propionate 400 μg/day in nasal spray after lavage . Patients from the third group received beclomethasone dipropionate 600 μg/day after lavage . The prevalence of infections and recurrence of polyposis was compared in the 3 groups . RESULTS : Three patients , 2 in the placebo group and 1 in the beclomethasone group , developed infections during the first 3 months after surgical procedure . The recurrence of polyps in the group without steroids was 44 % . In contrast , 15 % from the patients treated with fluticasone  showed recurrence of polyposis ; furthermore , 26 % of the patients treated with beclomethasone  showed recurrence of polypsosis , with a minimum follow-up of 12 months . CONCLUSIONS : The use of nasal steroids does not seem to increase the prevalence of infections after endoscopic polypectomy . ( Otolaryngol Head Neck Surg 2004;130:319–22 . This double-blind parallel-group study compared the effect of budesonide with placebo , in the prophylaxis of nasal polyp recurrence  after evulsion . Seventy-three patients with first time or recurrent polypectomy were enrolled . At revisits 3 and 6 months after evulsion , the budesonide-treated patients had significantly lower polyp scores than the placebo-treated patients . Only patients with recurrent nasal polyposis benefited from the budesonide treatment , whereas no effect was evident in patients with first time evulsion 60 patients , aged 15 - 51 years , with chronic allergic or bacterial maxillary sinusitis , were entered in a controlled , double-blind study comparing the efficacy of endonasal irrigations of tixocortol pivalate (Pivalone)-neomycin and neomycin . The treatment lasted 11 days and was administered once daily . A ventilometric measurement of sinus pressure was performed every two endonasal irrigations to assess treatment efficacy . The percentage of nasal deobstruction was significantly higher with tixocortol pivalate-neomycin than with neomycin alone by the fifth examination ( 9th day ) regardless of the etiology of the sinusitis ( allergic or bacterial ) . After 11 days of treatment , significantly better results were obtained in cases of bacterial sinusitis ( 94 % deobstruction with tixocortol pivalate-neomycin versus 74 % with neomycin ) than in cases of allergic sinusitis ( 69 % deobstruction with tixocortol pivalate-neomycin versus 36 % with neomycin ) In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring  dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials OBJECTIVES To investigate the effect of intranasal corticosteroids in the treatment of polyps in patients with severe polyposis listed for surgical treatment and to determine the treatment effect on the progression of the disease . DESIGN A double-blind , r and omized , parallel-group , placebo-controlled , 12-week study at a single center . SETTING A tertiary referral center in London , Engl and . PATIENTS Thirty-four patients with severe polyposis listed for endoscopic surgical treatment . INTERVENTION By r and om allocation , fluticasone propionate aqueous nasal spray ( FPANS ) , 200 microg twice a day ; beclomethasone dipropionate aqueous nasal spray , 200 microg twice a day ; or placebo nasal spray twice a day was administered . Patients received 2 actuations to each nostril in the morning and in the evening . MAIN OUTCOME MEASURES Efficacy end points were the need for polypectomy at the end of treatment , the results of acoustic rhinometry , the polyp score , the peak nasal inspiratory flow rate , and an assessment of symptoms . RESULTS The polyp score was significantly decreased in the FPANS-treated group ( P < or = .01 ) . The nasal cavity volume was significantly increased in both the FPANS-treated group and the group receiving beclomethasone compared with placebo ( P < or = .01 ) at the end of treatment . The percentage change in the mean morning peak nasal inspiratory flow rate was greater in the FPANS-treated group , with a significant effect observed at week 2 ( P = .01 ) . Nasal blockage was significantly decreased in both active groups compared with the group receiving placebo . No significant difference was observed between the treatment groups in the number of patients requiring polypectomy . CONCLUSIONS Fluticasone and beclomethasone aqueous nasal sprays are effective in treating the symptoms of severe nasal polyps . There was some evidence that the group treated with FPANS responded more quickly to intervention and that the magnitude of the response was greater than in the group receiving beclomethasone OBJECTIVE To assess the efficacy and safety of fluticasone propionate administered using OptiNose 's novel delivery device ( Opt-FP ) in subjects with bilateral mild-to-moderate nasal polyposis . METHODS A prospect i ve , multicentre , r and omized , double-blind , placebo-controlled , parallel group study was conducted in adult subjects ( n = 109 ) with mild-to-moderate bilateral nasal polyposis . Subjects received Opt-FP 400 microg or placebo twice daily for 12 weeks . Endpoints included endoscopic assessment of polyp size using Lildholdt 's Scale , peak nasal inspiratory flow ( PNIF ) , symptom scores and use of rescue medication . RESULTS The proportion of subjects with improvement in summed polyp score > or= 1 ( Lildholdt\ 's Scale ) was significantly higher with Opt-FP compared with placebo at 4 , 8 and 12 weeks ( 22 % vs 7 % , p = 0.011 , 43 % vs 7 % , p < 0.001 , 57 % vs 9 % , p < 0.001 ) . After 12 weeks the summed polyp score was reduced by 35 % ( -0.98 vs + 0.23 , p < 0.001 ) . PNIF increased progressively during Opt-FP treatment ( p < 0.05 ) . Combined symptom score , nasal blockage , discomfort , rhinitis symptoms and sense of smell were all significantly improved . Rescue medication use was lower ( 3.1 % vs 22.4 % , p < 0.001 ) . Opt-FP was well tolerated . CONCLUSIONS Fluticasone propionate ( 400 microg b.i.d . ) administered using OptiNose 's breath actuated bi-directional delivery device was an effective and well tolerated treatment for mild-to- moderate bilateral nasal polyposis OBJECTIVE To demonstrate the long-term efficacy of intranasal furosemide , an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell , vs no therapeutic intervention vs intranasal mometasone furoate , a corticosteroid , in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis . DESIGN R and omized prospect i ve controlled study . Patients were examined every 6 months during follow-up ( range , 1 - 9 years ) . PATIENTS One hundred seventy patients with bilateral obstructive or minimally obstructive chronic hyperplastic sinusitis with nasal polyposis . INTERVENTION All patients were surgically treated in the ENT Department , University of Siena Medical School . One month after surgery , group 1 patients ( n = 97 ) started treatment with intranasal furosemide , group 2 ( n = 40 ) received no therapeutic treatment , and group 3 ( n = 33 ) were treated with mometasone . MAIN OUTCOME MEASURES Clinical and instrumental evaluation of postoperative outcomes . RESULTS Seventeen ( 17.5 % ) of 97 patients in group 1 , 12 ( 30.0 % ) of 40 patients in group 2 , and 8 ( 24.2 % ) of 33 patients in group 3 experienced nasal polyposis relapses . We noted a prevalence of early-stage relapse in patients treated with furosemide or mometasone  , whereas patients who did not receive any treatment experienced more severe grade s of chronic hyperplastic sinusitis with nasal polyposis ( P<.005 ) . CONCLUSION Use of intranasal furosemide represents a valid therapeutic treatment in the prevention of chronic hyperplastic sinusitis with nasal polyposis BACKGROUND There is little evidence on the efficacy of glucocorticoid transnasal nebulization therapy in patients with eosinophilic chronic rhinosinusitis with nasal polyps ( CRSwNP ) . OBJECTIVE We sought to evaluate the immunologic and remodeling effects of budesonide transnasal nebulization in patients with eosinophilic CRSwNP . METHODS Sixty patients with eosinophilic CRSwNP were r and omized to receive budesonide or placebo treatment for 14 days by means of transnasal nebulization in a double-blind manner . Endoscopic polyp size scores ( maximum = 6 points , Kennedy score ) and visual analog scale scores for nasal symptoms were assessed before and after treatment . Similarly , polyp sample s 
    Output:
    
Other comparisons We identified no other studies that compared intranasal corticosteroids plus co-intervention A versus placebo plus co-intervention A. AUTHORS ' CONCLUSIONS Most of the evidence available was from studies in patients with chronic rhinosinusitis with nasal polyps .
There is little information about quality of life ( very low quality evidence ) .
For disease severity , there seems to be improvement for all symptoms ( low quality evidence ) , a moderate-sized benefit for nasal blockage and a small benefit for rhinorrhoea ( moderate quality evidence ) .
The risk of epistaxis is increased ( high quality evidence ) , but these data included all levels of severity ; small streaks of blood may not be a major concern for patients .
It is unclear whether there is a difference in the risk of local irritation ( low quality evidence )