Background. Thermal water inhalations and irrigations have a long tradition in the treatment of airway diseases. Currently there exists no systematic review or meta-analysis on the effectiveness of thermal water treatment in upper respiratory tract diseases. Methods. A systematic search in the databases of MEDLINE, EMBASE, CENTRAL, ISI Web of Science, and MedPilot was accomplished. Results. Eight evaluable outcome parameters from 13 prospective clinical studies were identified for 840 patients. Mucociliary clearance time improves significantly ( ) for the pooled thermal water subgroup and the sulphurous subgroup after 2 weeks (？6.69/minutes) and after 90 days (？8.33/minutes), not for isotonic sodium chloride solution (ISCS). Nasal resistance improved significantly after 2 weeks (Radon, ISCS, and placebo), after 30 days (sulphur and ISCS), and after 90 days (sulphur). Nasal flow improved significantly with the pooled thermal water, radon alone, and ISCS subgroups. For the IgE parameter only sulphurous thermal water ( ) and ISCS ( ) were analyzable. Adverse events of minor character were only reported for sulphurous treatment (19/370). Conclusion. Thermal water applications with radon or sulphur can be recommended as additional nonpharmacological treatment in upper airway diseases. Also in comparison to isotonic saline solution it shows significant improvements and should be investigated further. 1. Introduction Upper airway diseases compass acute and chronic conditions. In this study, we focus on recurrent upper respiratory tract infections (RURT), allergic rhinitis (AR), nonallergic rhinitis (NAR), and acute and chronic rhinosinusitis (ARS/CRS) with and without nasal polyps. These disorders are extremely common and present in all ages, all ethnic populations, and all countries [1]. Apart from their high socioeconomic burden [2], “comorbidities are common and increase the complexity of the management and costs” [1]. Rhinitis is a symptomatic inflammation of the nasal mucosa including nasal symptoms like rhinorrhea, nasal obstruction, nasal itching, and sneezing [3]. The most common form of noninfectious rhinitis is AR with immunoglobulin E- (IgE-) mediated immune response after allergen exposure [1]. Nonallergic rhinitis shows periodic or perennial symptoms, which are not IgE-dependent such as infectious or vasomotor rhinitis [4]. Infectious rhinitis has either viral, bacterial, or other infectious agents origin [3] and affects millions of people annually [5]. Rhinitis and sinusitis mostly coexist and have been proposed as rhinosinusitis [6]. The
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