Sulfurous-arsenical-ferruginous thermal water nasal inhalation and irrigation in children with recurrent upper respiratory tract infections: Clinical outcomes and predictive factors

Am J Otolaryngol. 2021 Nov-Dec;42(6):103083. doi: 10.1016/j.amjoto.2021.103083. Epub 2021 May 21.


Purpose: Recurrent upper respiratory disorders (RURD) are among the most common problems diagnosed in pediatric otolaryngology practice. Although several preliminary studies have demonstrated beneficial effects of thermal water inhalations for RURD, inhalation of thermal water has not been included among validated management protocols. The effects of sulfurous-arsenical-ferruginous thermal water nasal irrigations have been confirmed also in prospective, randomized studies. The main aim of this explorative, retrospective, observational study has been to compare the clinical outcome in pediatric patients with RURD treated with sulfurous-arsenical-ferruginous thermal water inhalation versus combined inhalation and nasal irrigation.

Methods: Two hundred and fifty-three pediatric patients with RURD were considered; 231 underwent thermal water inhalations (inhalation of hot humid air and aerosol) only, while 22 underwent nasal irrigations combined with inhalations. Subjective overall efficacy perception and treatment tolerability were scored as categorical variables (from 0 = no efficacy/worst tolerability to 3 = maximal efficacy/best tolerability).

Results: Nasal obstruction, sneezing, serous, mucous, and purulent rhinorrhea, cough, and snoring improved respectively in 80.2%, 72.9%, 79.0%, 93.8%, 92.3%, 64.8%, and 60.4% of patients referring these symptoms at presentation, respectively. No statistically significant differences between inhalations alone and combined inhalations and irrigations emerged. The median overall efficacy perception score was 2 while the median treatment tolerability score was 3.

Conclusions: This investigation found that sulfurous-arsenical-ferruginous water treatment was a well-tolerated therapeutic option for selected pediatric patients with RURD. These promising preliminary results should be confirmed in prospective, randomized, double-blind settings, also using minimally invasive but objective and quantitative evaluation methods.

Keywords: Inhalations; Irrigations; Pediatric; Recurrent upper respiratory disorders; Sulfurous-arsenical-ferruginous water.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Administration, Inhalation
  • Administration, Intranasal / methods*
  • Adolescent
  • Arsenicals / administration & dosage*
  • Bridged Bicyclo Compounds, Heterocyclic / administration & dosage*
  • Child
  • Child, Preschool
  • Female
  • Hot Temperature
  • Humans
  • Male
  • Nasal Lavage / methods*
  • Recurrence
  • Respiratory Tract Infections / drug therapy*
  • Retrospective Studies
  • Sulfur / administration & dosage*
  • Temperature
  • Therapeutic Irrigation / methods*
  • Treatment Outcome
  • Water / administration & dosage*


  • Arsenicals
  • Bridged Bicyclo Compounds, Heterocyclic
  • ferruginine
  • Water
  • Sulfur