***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: A r and omized comparison of the usual surgical removal of nasal polyps versus systemic steroid treatment was performed in 53 patients . In all , continuous topical steroid treatment was given during the one year period of observation . In both groups the initial treatment result ed in a continuous increase in mean nasal expiratory peak flow as well as in the sense of smell ; these two parameters showed a temporary statistically significant difference in favour of the medically treated group . In general though , the results in the two treatment groups were alike . Therefore medical treatment is recommended for routine use . Surgical removal should be reserved for those few cases in which the presence of residual or recurrent polyps justifies the inherent risks and discomfort for the patient Patients with nasal polyps present repeatedly in otorhinolaryngology practice s , but the prevalence of nasal polyps in the general population is not known . Our objective was to investigate the prevalence of nasal polyps in an adult Swedish population in relation to age , gender , asthma , and aspirin intolerance . A r and om sample of 1,900 inhabitants over the age of 20 years , stratified for age and gender , was drawn from the municipal population register in Skövde , Sweden , in December 2000 . The subjects were called to clinical visits that included questions about rhinitis , asthma , and aspirin intolerance and examination by nasal endoscopy .  In total , 1,387 volunteers ( 73 % of the sample ) were investigated . The sample size was adequate , with a good fit to the whole population .  The prevalence of nasal polyps was 2.7 % ( 95 % confidence interval , 1.9–3.5 ) , and polyps were more frequent in men ( 2.2 to 1 ) , the elderly ( 5 % at ≥60 years of age ) , and asthmatics . Subjective symptoms of aspirin intolerance were not found to correlate with polyps . Nasal polyps were more common in adults than was stated by the a priori estimate . The Skövde population -based study is considered representative for the Swedish population OBJECTIVE To reevaluate the current criteria for diagnosing  allergic fungal sinusitis ( AFS ) and determine the incidence of AFS in patients with chronic rhinosinusitis ( CRS ) . METHODS This prospect i ve study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis , of whom 101 were treated surgically . Collecting and culturing fungi from nasal mucus require special h and ling , and novel methods are described . Surgical specimen h and ling emphasizes histologic examination to visualize fungi and eosinophils in the mucin . The value of allergy testing in the diagnosis of AFS is examined . RESULTS Fungal cultures of nasal secretions were positive in 202 ( 96 % ) of 210 consecutive CRS patients .  Allergic mucin was found in 97 ( 96 % ) of 101 consecutive surgical cases of CRS . Allergic fungal sinusitis was diagnosed in 94 ( 93 % ) of 101 consecutive surgical cases with CRS , based on histopathologic findings and culture results . Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients . CONCLUSION The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis . Since the presence of eosinophils in the allergic mucin , and not a type I hypersensitivity , is likely the common denominator in the pathophysiology of AFS , we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis The effects of rhinosinusitis treatment upon asthma are disputed . The first r and omised prospect i ve study of surgical compared with medical therapy of chronic rhinosinusitis in 90 patients with and without nasal polyps was previously reported . Asthma symptoms , control , forced expiratory volume in one second ( FEV1 ) , peak flow , exhaled nitric oxide , medication use and hospitalisation at 6 and 12 months from the start of the study were also monitored . This paper reports these results in 43 of those patients with concomitant asthma . Both medical and surgical treatment of chronic rhinosinusitis were associated with subjective and objective improvements in asthma . Overall asthma control improved significantly following both treatment modalities , but was better maintained after medical therapy , where improvement could also be demonstrated in the subgroup with nasal polyps . Medicine was superior to surgery with respect to a decrease in exhaled nitric oxide and increase in FEV1 in the polyp patients . Two patients noted worsening of asthma post-operatively . Improvement in upper airway symptoms , as assessed using a visual analogue scale , correlated with improvement in asthma symptoms and control . Treatment of chronic rhinosinusitis , medical or surgical , benefits concomitant asthma ; that associated with nasal polyposis benefits more from medical therapy OBJECTIVES To conduct the first prospect i ve r and omized controlled trial , evaluating and comparing the effect of medical and surgical treatment of chronic rhinosinusitis ( CRS ) on quality of life . MATERIAL S AND METHODS Ninety patients with CRS , who remained symptomatic after initial medical treatment with Dexarhinaspray duo and nasal douche , were r and omized either to medical or surgical therapy .  All patients underwent pre- and post-treatment assessment s of the Sinonasal Outcome Test-20 ( SNOT-20 ) , and the Short Form 36 Health Survey ( SF-36 ) . Each patient had three assessment s : before starting the r and omized treatment , after six months and finally after one year . RESULTS Both the medical and surgical treatment of CRS significantly improved almost all the parameters of SNOT and SF-36 ( p<0.05 ) , with no significant difference being found between the medical and surgical groups ( p>0.05 ) . CONCLUSION Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients , providing further evidence that chronic rhinosinusitis should be targeted with maximal medical therapy in the first instance , with surgical treatment being reserved for cases refractory to medical therapy . The presence of nasal polyps does not imply any negative effect on the quality of life after CRS therapy , either medical or surgical BACKGROUND The treatment of nasal polyps is controversial , and medical treatment alone has been little investigated to our knowledge . OBJECTIVE To examine the efficacy of therapy using only topical budesonide powder and topical budesonide powder supplemented with surgical removal or intramuscular betamethasone . DESIGN R and omized , double-blind comparison of 2 dosages and additional treatment , if therapy failed . After 1 year , treatment with medication was stopped , and the dem and for renewed treatment was monitored for another year . PATIENTS Patients with bilateral nasal polyps who dem and ed treatment were consecutively enrolled in a hospital outpatient clinic or specialty private practice . During a 15-month period from 1990 to 1992 , a total of 126 patients entered the 2-year study . INTERVENTIONS In phase 1 , r and omized and double-blind treatment with a topical medication , budesonide powder , 800 micrograms or 400 micrograms daily , or a placebo was given for 1 month . In phase 2 , r and omized and double-blind treatment with budesonide powder , 800 micrograms or 400 micrograms daily , was given . At the end of phase 1 , failed therapy was supplemented by r and omly assigned treatment of either surgical removal or a single injection of sustained released betamethasone . In phase 3 , treatment with the medication was discontinued , and patients were monitored for another year . The time when treatment was required again was noted . The present article deals with phases 2 and 3 . MAIN OUTCOME MEASURES Patients ' scores of treatment efficacy as well as symptoms and signs . Semiquantitative measurement of sense of smell and calculation of peak expiratory flow rate index based on nasal and oral peak expiratory flow . RESULTS In all outcome measures , a comparison of the data before treatment with the corresponding figures during phase 2 showed statistically significant efficacy . The clinical course was described at the end of phase 2 . About 85 % of the patients , including those who received additional therapy because the initial therapy failed , rated total or substantial control over the symptoms . The 2 dosages investigated showed equal results . These findings were consistent with the signs recorded and the peak expiratory flow rate index . The results of phase 3 showed that 50 % of patients had dem and ed treatment after 4 months , while 34 % managed without medication after 1 year . CONCLUSIONS The clinical course in this study showed that most patients with nasal polyps do well with medical treatment . Therefore , surgery was required in few patients . However , the potential of medical treatment should be further explored in future studies BACKGROUND Nasal polyposis ( NP ) is a frequent inflammatory chronic disease of the upper respiratory tract , which may impair quality of life ( QOL ) . The NP impact , which is frequently associated with lower respiratory disorders , has never before been studied . OBJECTIVE We initiated this prospect i ve study to establish internal validity and reliability of the generic SF-36 question naire in NP and to determine to what level daily functioning becomes impaired as a result of NP . METHODS Forty-nine consecutive patients with NP were included . They were assessed for the severity of nasal symptoms and underwent pulmonary function tests . The QOL profiles in patients with NP were compared with those of patients with perennial rhinitis ( n = 111 ) and healthy subjects ( n = 116 ) . RESULTS Cronbach 's coefficient alpha demonstrated the high reliability and validity of the SF-36 question naire for patients with NP ( alpha = .89 ) . NP impaired QOL more than perennial allergic rhinitis ( P < .05 ) . The impairment of QOL was greater when NP was associated with asthma ( P < .05 ) . SF-36 scores appeared highly correlated to pulmonary function ( FEV1 , maximal midexpiratory flow , forced vital capacity ) , suggesting relationships between QOL in NP and associated bronchial obstruction . Severity of nasal symptoms were not related to QOL scales . In addition , sequential evaluations of QOL , nasal symptoms , and pulmonary function were performed 10 months after the first evaluation in 28 patients with NP . These evaluations demonstrated that NP treatment either with nasal steroids or endonasal ethmoidectomy significantly improved both nasal symptoms and QOL without significant change of pulmonary function . CONCLUSION Our study clearly demonstrated that the SF-36 question naire presented a high internal validity and reliability in patients with NP . NP impaired QOL to a greater degree than perennial allergic rhinitis . QOL improvement after NP treatment is related to nasal symptoms improvement OBJECTIVES /HYPOTHESIS Genetic etiology is suspected in the development of nasal polyposis on the basis of familial aggregation . This study investigated whether there is an association between HLA-DRB1 , -DQA1 , and -DQB1 alleles and developing nasal polyposis . STUDY DESIGN Data from 50 polypectomized patients were compared with data from 50 healthy r and omly selected controls .  Polyp score , possible asthma , aspirin sensitivity , and ASA triad were also recorded . METHODS Genotyping of HLA-DRB1 alleles was carried out with the Dynal RELI SSO HLA-DRB , a direct DNA probe test that utilizes a polymerase chain reaction ( PCR ) and nucleic acid hybridization for the differentiation of 70 HLA-DRB alleles and 9 supertypes . For DQA1 * genotyping PCR-RFLP ( restriction fragment length polymorphism ) was used , differentiating eight alleles . The DQB1 * typing was carried out using a INNO-LiPA DQB PCR-reverse hybridization kit , allowing the discrimination of 30 alleles . RESULTS People carrying the HLA-DR7-DQA1 * 0201 , and -DQB1 * 0202 haplotype were found to have a two to three times higher odds ratios ( ORs ) for developing the disease , compared with controls . Patients with ASA triad carried the above-mentioned DR7 allele with the linked alleles significantly more often ( P < .001 ) . Subjects carrying HLA-DR5 allele and the linked alleles had lower odds ratio values . CONCLUSION These results underline that allergy is not conditional for the formation of nasal polyps as thought before . Nasal polyposis associated with asthma and aspirin sensitivity is probably a unique form of nasal polyps . The authors plan further investigations in this field Our underst and ing of fungi in chronic rhinosinusitis ( CRS ) has been limited by previously employed detection techniques . This study examines the fungal component of the microbiome in CRS patients and controls using a highly sensitive culture‐independent molecular technique . The aims of this study include the characterization of fungal richness , prevalence , abundance , temporal changes , and their relationship with patient outcomes OBJECTIVES To conduct the first prospect i ve , r and omized , controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis ( CRS ) . MATERIAL S AND METHODS Ninety patients with CRS were equally r and omized either to medical or surgical therapy . All patients underwent pre- and posttreatment assessment s of visual analogue score ( VAS ) , the Sinonasal Outcome Test-20 ( SNOT-20 ) , the Short Form 36 Health Survey ( SF-36 ) , nitric oxide ( NO ) , acoustic rhinometry , saccharine clearance time ( SCT ) , and nasal endoscopy .  Each patient had three assessment s : before starting the treatment , after 6 months , and 
    Output:
    
PRIMARY OUTCOMES symptom scores and quality of life scores There were no important differences between groups in either the patient-reported disease-specific symptom scores or the health-related quality of life scores .
No differences were found for any objective measurements or olfactory tests in those studies in which they were measured .
The evidence does not show that one treatment is better than another in terms of patient-reported symptom scores and quality of life measurements .