***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: Treatment of naso-sinus polyposis has been the subject of much controversy . The large number of reports in the literature suggest that role of surgical treatment is on the uprise . There is however general agreement that medical treatment is fundamental although an insufficient number of studies have evaluated its efficacy . The aim of this prospect i ve study was to evaluate results 6 months , 12 months and 2 years after  medical treatment of polyposis in 181 patients . Despite a well-coduced information protocol , nearly 19 % of the patients were lost to follow-up . Less than 32 % of the patients have been operated . Patients treated medically were given a st and ard regimen according to a protocol combining short-term oral corticosteroids ( prednisolone ) and steroid nasal spray ( beclometasone ) . Treatment was successful in 68 % of the patients given medical treatment alone . Mean symptom intensity declined by 35 to 80 % at 6 months then remained unchanged to the end of the study ( 2 years follow-up ) . Mean doses of prednisolone and beclomethasone  were evaluated . Doses could be tapered off progressively allowing satisfactory nasal comfort .  Medical treatment should be the first line therapy for nasal polyposis . Surgery should not be proposed until corticosteroid therapy has been found to be unsuccessful over a mean 6 months of a well-conducted treatment and good patient compliance We started therapy sinusitis of our patients with antibiotics cefuroxime axetil ( Zinnat , GSK ) , clarithromycin ( Klacid Uno , Abbott ) and  orally given steroid-prednisone in one group ( A+S ) 56 patients . Second group of 60 patients were cured only with antibiotics ( A ) . We compare effects of this therapy . There were 50 % totally cured patients in the first group ( A+S ) and 46.6 % cured in the second group . Percentage totally cured patients with ( A+S ) is 3.4 % better that cured only with antibiotics in the same time . It is statistically important . We present benefits for patients who were operated in the next step . Post therapy with the use of antibiotics and steroids there were less bleeding from the mucosal membrane , and there was no edema . It is a good method of therapy if patients have no contraindications 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 BACKGROUND There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps . OBJECTIVE We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps . METHODS In a double-blind , placebo-controlled , multicenter trial , we r and omly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses ( 32 - 8 mg once daily ) , doxycycline ( 200 mg on the first day , followed by 100 mg once daily ) , or placebo for 20 days . Participants were followed for 12 weeks . Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy . Markers of inflammation such as eosinophilic cationic protein ( ECP ) , IL-5 , myeloperoxidase , matrix metalloproteinase 9 , and IgE were measured in nasal secretions . Concentrations of eosinophils , ECP , and soluble IL-5 receptor alpha were measured in peripheral blood sample s. RESULTS Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo . The effect of methylprednisolone was maximal at week 3 and lasted until week 8 , whereas the effect of doxycycline was moderate but present for 12 weeks . Methylprednisolone significantly reduced levels of ECP , IL-5 , and IgE in nasal secretions , whereas doxycycline significantly reduced levels of myeloperoxidase , ECP , and matrix metalloproteinase 9 in nasal secretions . CONCLUSION This is the first double-blind , placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps , nasal symptoms , and mucosal and systemic markers of inflammation Background Although combined oral and nasal steroid therapy is widely used in nasal polyposis , a subset of patients show an unfavorable therapeutic outcome . This study aim ed to evaluate whether oral prednisolone produces any additive effects on subsequent nasal steroid therapy and to evaluate if any clinical variables can predict therapeutic outcome . Methods Using a 3:2 r and omization ratio , 67 patients with nasal polyposis received 50 mg of prednisolone and 47 patients received placebo daily for 2 weeks , followed by mometasone furoate nasal spray ( MFNS ) at 200 micrograms twice daily for 10 weeks . Clinical response was evaluated by nasal symptom score ( NSS ) , peak expiratory flow index ( PEFI ) , and total nasal polyps score ( TNPS ) . Potential predictor variables were assessed by clinical history , nasal endoscopy , allergy skin test , and sinus radiography . Results At the end of the 2-week oral steroid phase , the prednisolone group showed significantly greater improvements in all nasal symptoms , nasal airflow , and polyp size than the placebo group . In the nasal steroid phase , while the MFNS maintained the outcome improvements in the prednisolone group , all outcome variables in the placebo group showed continuing improvements . At the end of the nasal steroid phase , there re no significant differences of most outcome improvements between the two groups , except in hyposmia , PEFI , and TNPS ( p = 0.049 , p = 0.029 , and p = 0.005 , respectively ) . In the prednisolone group , patients with polyps grade 3 and endoscopic signs of meatal discharge showed significantly less improvement in total NSS , PEFI , and TNPS than patients with grade 1–2 size and negative metal discharge . Conclusion In the 12-week treatment evaluation of nasal polyposis , pretreatment with oral steroids had no significant advantage for most nasal symptoms other than earlier relief ; however , combined oral and nasal steroid therapy more effectively improved hyposmia , polyps size , and nasal airflow . Polyps size grade 3 and /or endoscopic signs of meatal discharge predisposed to a poorer treatment outcome BACKGROUND Controlled prospect i ve studies are needed to determine whether surgical treatment in fact has an effect additive to that of medical treatment of nasal polyposis . OBJECTIVE We sought to compare the effect of medical treatment versus combined surgical and medical treatment on olfaction , polyp score , and symptoms in nasal polyposis . METHODS Thirty-two patients with nasal polyposis and symmetrical nasal airways were r and omized to unilateral endoscopic sinus surgery after pretreatment with oral prednisolone for 10 days and local nasal budesonide bilaterally for 1 month . Postoperatively , patients were given local nasal steroids ( budesonide ) . Patients were evaluated with nasal endoscopy , symptom scores , and olfactory thresholds . They were followed for 12 months . RESULTS The sense of smell was improved by the combination of local and oral steroids . Surgery had no additional effect . Symptom scores improved significantly with medical treatment alone , but surgery had additional beneficial effects on nasal obstruction and secretion . After surgery , the polyp score decreased significantly on the operated side but remained the same on the unoperated side . Twenty-five percent of the patients were willing to undergo an operation also on the unoperated side at the end of the study . CONCLUSIONS Medical treatment seems to be sufficient to treat most symptoms of nasal polyposis . When hyposmia is the primary symptom , no additional benefit seems to be gained from surgical treatment . If nasal obstruction is the main problem after steroid treatment , surgical treatment is indicated . Selection of those who will benefit from surgery should be based on the patient 's symptoms and not on the examiner 's polyp score 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 /HYPOTHESIS To assess the effect of oral plus intranasal corticosteroids on subjective outcomes ( smell and nasal congestion ) and objective outcomes ( tissue eosinophilia and nitric oxide ) in severe nasal polyposis ( NP ) . STUDY DESIGN After a 4-week steroid washout period ( w0 ) , severe NP were r and omized into a treatment group ( n = 67 ) that receive oral prednisone for 2 weeks ( w2 ) plus intranasal budesonide for 12 weeks ( w12 ) , and a control group ( n = 22 ) that received no steroid treatment .  METHODS Barcelona Smell Test 24 ( BAST-24 ) , nasal congestion , tissue eosinophilia , and nasal nitric oxide ( nNO ) were assessed . RESULTS Before treatment , patients showed a significant impairment of smell detection ( 30.7 ± 39.5 % ) , identification ( 7.1 ± 16.1 % ) , and forced choice ( 13.8 ± 23.3 % ) in BAST-24 compared to healthy population . At w2 , the treatment group showed a significant improvement in detection , identification , and forced choice . Positive effect was also seen after 12 weeks of intranasal corticosteroids . A significant reduction of nasal congestion ( 1.17 ± 1.0 vs. 2.73 ± 0.5 ) and polyp tissue eosinophilia ( 10.9 ± 4.2 vs. 41.2 ± 12.2 ) with an increase of nNO ( 650 ± 317 vs. 420 ± 221 ppb ) were observed at w2 compared to w0 and to the control group . These effects were also seen at w12 . CONCLUSIONS Combined oral and intranasal corticosteroids improve smell and nasal congestion and decrease nasal inflammation , as measured by reduced tissue eosinophilia and increased detection of nNO . Severity of smell loss correlates with degree of nasal congestion but not with inflammation , as measured by tissue eosinophilia or nasally exhaled nNO . Our findings suggest that improvement in smell may be related to improved conduction of odorants to the olfactory neuroepithelium OBJECTIVE To investigate endoscopic staging , and nitric oxide levels in the polyp tissue , in patients with nasal polyposis undergoing glucocorticoid therapy .  METHODS Nasal polyposis was evaluated using endoscopic staging and measurement of polyp tissue nitric oxide levels ( chemiluminescence method ) . Forty-five nasal polyposis patients received either nasal therapy ( n = 15 ) , oral therapy ( n = 15 ) or combined therapy ( n = 15 ) . Pre-treatment and post-treatment staging and nitric oxide levels were evaluated . RESULTS Endoscopic grading indicated significant post-treatment staging improvements in the oral ( p = 0.016 ) and combined ( p = 0.016 ) groups . Post-treatment staging differed significantly between the three groups ( p = 0.041 ) , with greater improvements in the oral and combined groups . All groups showed significantly lower post-treatment nitric oxide levels , compared with baseline , but post-treatment levels did not differ significantly between groups . A significant association was found between treatment response and nitric oxide level alteration . CONCLUSION This study demonstrates the favourable effects of glucocorticoids on nasal polyposis , and alteration in nitric oxide tissue levels post-treatment . Nitric oxide level in nasal polyp tissue could be an indicator of treatment response 
    Output:
    
At the end of the treatment course ( two to three weeks ) there is an improvement in health-related quality of life and symptom severity in patients with chronic rhinosinusitis with nasal polyps taking oral corticosteroids compared with placebo or no treatment .
At three to six months after the end of the oral steroid treatment period , there is little or no improvement in health-related quality of life or symptom severity for patients taking an initial course of oral steroids compared with placebo or no treatment .
The data on the adverse effects associated with short courses of oral corticosteroids indicate that there may be an increase in insomnia and gastrointestinal disturbances but it is not clear whether there is an increase in mood disturbances .
There is no evidence for oral steroids compared with other treatments