***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 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 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 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 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 Chronic rhinosinusitis ( CRS ) is a common condition and affects the quality of life of approximately 16 % of adults in US and 10.9 % in Europe . Hyaluronan ( HA ) is a nonsulphate glycosaminoglycan found in the extracellular matrix of connective tissues , and plays an important role in the healing process and repair of mucosal surfaces . We aim to evaluate the effect of HA on nasal symptoms and endoscopic appearance in patients with CRS and nasal polyps ( NP ) who have not undergone sinus surgery . Eighty patients older than 18 years old were r and omized to receive either open-label nebulized saline solution ( NS ) or intranasal corticosteroid spray ( ICS ) 200 µg bid or nebulized sodium hyaluronate ( NHA , YABRO ® ) or both ICS and NHA . Results were collected at 1 month , 3 months and 3 months after treatment . Significant improvements in nasal symptoms scores , endoscopic appearance scores , radiologic scores , rhinomanometry and saccharine clearance test were observed in the NHA , ICS and ICS + NHA groups after 1 month and 3 months of treatment compared with baseline ( all p ≤ 0.005 ) . The use of oral steroids was significantly reduced after 3 months of therapy in the same groups versus baseline ( all p < 0.05 ) . The incidence of adverse events at 3 months was similar between the 4 groups ( all p > 0.05 ) . Throat irritation , nasal burning and drug-related epistaxis were not reported in the group NHA . HA , as a nebulized nasal douche preparation , improved nasal symptoms and endoscopic appearances in patients with CRS and NP who have not undergone sinus surgery 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 Sinonas 
    Output:
    
The evidence suggests that there is no benefit of a low-volume ( 5 ml ) nebulised saline spray over intranasal steroids .