Thermal Water Applications in the Treatment of Upper Respiratory Tract Diseases: A Systematic Review and Meta-Analysis

Table 2

Systematic presentation of the studies included.

Author	Year	Jadad score	Number of patients thermal water/control	Age span/average age	Duration of treatment	Measurement time points	Inclusion criteria	Exclusion criteria
De Luca et al. [53]	2006	3	40/—	74–100/86,5	12 days	Baseline; Follow-Up: Day 12	(i) Presence of chronic rhinitis or chronic rhinosinusitis; (ii) Allergic or vasomotor nasal hyperactivity; (iii) Chronic laryngitis; (iv) Chronic pharyngitis	(i) Acute pathologies in ENT region; (ii) Steroids, mucolytics, antihistamine, NSAIDs, vasoconstrictive drugs or antibiotics in the last 30 days; (iii) Autoimmune disease; (iv) Patients with malignant neoplasms, surgical intervention, and/or radio chemotherapy
Marullo and Abramo [29]	2000	3	27/20	15–81/52.4	12 days	Baseline; Follow-Up: Day 12	(i) At least 3 confirmed episodes of sinonasal infection in the previous 12 months; (ii) Evidence of chronic sinonasal inflammation at objective otorhinolaryngologic evaluation	(i) Vasoconstrictive drugs, local and systemic steroids, NSAIDs, antihistamine, and mucolytics in the last 2 months; (ii) Patients who for various reasons were not able to ensure the conclusion of the study; (iii) Patients who present anterior rhinoscopy
Miraglia del Giudice et al. [60]	2011	5	20/20	6–14/	15 days a month for 3 months	Baseline; Follow-Up: Week 12, 14	(i) Age from 6 to 14; (ii) History of seasonal moderate to severe allergic rhinitis for at least 2 years; (iii) Positive skin prick test to Parietaria pollen; (iv) History of mild intermittent asthma	(i) Antihistamines, intranasal, bronchial, or systemic corticosteroids, cromolyn sodium, and leukotriene modifiers in the previous 6 weeks; (ii) sinus and/or upper or lower respiratory tract infection, persistent asthma, nasal surgery within the last year, respiratory tract abnormalities, and systemic diseases
Ottaviano et al. [27]	2012	5	35/35	18–65/; not specified	12 weeks	Baseline; Follow-Up: Day 30, 90	(i) Age from 18 to 65; (ii) Nonallergic chronic rhinitis; (iii) Cigarette smoking habit for at least 5 years	Autoimmune diseases, cystic fibrosis, and diabetes
Ottaviano et al. [28]	2011	8	40/40	18–65/; not specified	1 month	Baseline; Follow-Up: Day 30	(i) Age from 18 to 65; (ii) Nonallergic chronic rhinosinusitis	Autoimmune diseases, cystic fibrosis, and diabetes
Passali et al. [58]	2013	3	33/—	12 years and older/; not specified	14 days	Baseline; Follow-Up: Day 14	(i) Nasal obstruction evaluated by a 10-point Visual Analog Scale (1: nasal airways completely free; 10: nasal airway completely blocked) higher than 7 in the previous 2 months; (ii) Chronic rhinosinusitis, persistent allergic rhinitis, vasomotor rhinitis with inferior turbinate hypertrophy	(i) Acute viral rhinitis; (ii) Obstructive polyposis; (iii) Nasal steroid, vasoconstrictive drug therapies or systemic NSAIDs, oral steroids and mucolytic treatment in the previous 2 months
Passali et al. [59]	2008	3	60/60	15–65/not specified	14 days	Baseline; Follow-Up: Day 14	Chronic rhinosinusitis with/or nasal polyposis of I second degree of the Lund-Mackay-Classification [62]	Not specified
Passariello et al. [57]	2012	3	60/—	2–12/3.4 ± 1	15 days	Baseline; Follow-Up: Day 15	(i) Age from 2 to12; (ii) CRS; (iii) One or more of the following sinonasal symptoms: nasal discharge, congestion, obstruction, postnasal drip, daytime cough, and foul breath; (iv) Failed courses of antibiotics, saline irrigation, nasal steroids, or antihistamine; (v) Persistent symptoms for ≥1 month	(i) Steroids, nonsteroidal anti-inflammatory drugs, antihistamines, and vasoconstrictors in the previous 4 weeks; (ii) Primary diagnosis of obstructive sleep apnea syndrome caused by tonsillar hyperplasia; (iii) Chronic diseases, immunodeficiency, and neurological impairment; (iv) Varicose veins of the nasal septum, and suspect ciliary abnormalities; (v) Previous sinonasal surgery; (vi) Malformation of the upper airway; sinonasal osteogenesis, tumors, and obstructive lesions; (vii) History of facial trauma that distorted the sinus anatomy
Salami et al. [26]	2010	5	40/40	26–58/46.4	12 days	Baseline; Follow-Up: Day 12, 90	CRS without polyps	(i) Immunostimulant or immunosuppressive agents in the previous 6 months; (ii) Genetic and congenital condition: cystic fibrosis and primary ciliary dyskinesia; (iii) Nasal polys; (iv) Positive allergy testing; (v) Anatomic abnormalities (severe septal deviation among others); (vi) Acquired mucociliary dysfunction; (vii) Neoplasms; (viii) Acute contemporary bacterial and/or viral rhinosinusitis, middle ear, and respiratory tract; (ix) Bronchopulmonary disease; (x) Nasal trauma; (xi) Smoker; (xii) Previous nasal and sinus surgery
Salami et al. [25]	2008	7	50/50	6–14/9	12 days	Baseline; Follow-Up: Day 12, 90	At least 3 acute episodes of upper respiratory tract infections in the last year	(i) Immunostimulant or immunosuppressive agents in the previous 6 months; (ii) Previous adenoidectomy and/or tonsillectomy; (iii) Anatomic anomalies; (iv) Other acute infections; (v) Allergic rhinitis; (vi) Congenital immunodeficiency’s; (vii) Pulmonary disease
Staffieri et al. [56]	2008	5	40/40	18–65/not specified	6 months	Baseline; Follow-Up: Day 30, 90, 180	(i) Age from 18 to 65; (ii) CRS not responding to medical treatment; (iii) No contraindications to general anaesthesia and FESS	(i) Autoimmune disease; (ii) Cystic fibrosis; (iii) Diabetes; (iv) Sinonasal inverted papilloma or sinonasal malignancy
Staffieri and Abramo [55]	2007	4	37/—	40/not specified	12 days	Baseline; Follow-Up: Day 12	(i) At least 3 confirmed episodes of sinonasal infection in the previous 12 months; (ii) Evidence of chronic sinonasal inflammation at otorhinolaryngologic endoscopic evaluation	Nasal steroid, vasoconstrictive drug therapies or systemic NSAIDs, and steroid or mucolytic treatments in the previous 2 months
Staffieri et al. [54]	1998	3	25/25	18–83/50.5	12 days	Baseline; Follow-Up: Day 12	Chronic rhinopharyngotubaric inflammation	Not specified