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Smoking and chronic rhinitis: effects of nasal irrigations with sulfurous-arsenical- ferruginous thermal water. a prospective, randomized, double-blind study.

Keywords: Chronic Rhinitis in Smokers; Thermal Water Nasal Washing; Rhinomanometry; Nasal Cytology; Olfactory Threshold

Introduction and Objectives

Smoking is a self-destructive behavior (1) that is known to induce remodeling of the lower airways, leading to squamous metaplasia, but little is known about its effects on the nose and paranasal sinuses (2). Smoking is a strong independent risk factor of olfactory impairment (3) probably as consequence of anatomical changes that occur in the olfactory mucosa, such as squamous metaplasia (4) and a reduction in the number and size of the olfactory vessels and cilia (5). Nasal irrigations are often mentioned as measures for treating sinonasal inflammations. Unfortunately, studies conducted on the benefits of nasal irrigations have often been small and poorly controlled, and their conclusions have not always been evidence-based (6). The purpose of our study was to compare the effects of nasal irrigations with sulfurousarsenical-ferruginous thermal water or isotonic sodium chloride solution in smokers with non-allergic chronic rhinosinusitis, based on clinical and olfactory evidences.

Materials and Methods

The present was a prospective, randomized, double-blind study performed in a tertiary academic referral center. Seventy smokers with non-allergic chronic rhinitis were enrolled. Nasal endoscopy, rhinomanometry, nasal cytology and odor threshold measurements were performed in subjects randomized to daily nasal irrigations with either thermal water or isotonic sodium chloride solution for 1 month.


Immediately after the treatment, the thermal water irrigations revealed a positive pharmacological action, judging from a tendency towards lower nasal resistances (p=0.07), and larger numbers of ciliated cells in the patients treated (p=0.003). Endoscopic findings in the thermal water group were still better than in the control group a further two months later (p=0.03).


Our results indicate that nasal irrigations with thermal water had a good effect on endoscopic objective signs, nasal resistances and epithelial trophism.


(1.) Rudolph S, Schu U, Herrmann-Lingen Ch., Werner JA, Folz BJ. Nasal manifestations of self-destructive behaviour. Rhinology 2007;45:299-304

(2.) Coggins CR. A review of chronic inhalation studies with mainstream cigarette smoke in rats and mice. Toxicol Pathol 1998;28:307-14.

(3.) Katotomichelakis M, Balatsouras D, Tripsianis G, Davris S, Maroudias N, Danielides V, Simopoulos C. The effect of smoking on the olfactory function. Rhinology 2007;45:273-80.

(4.) Yee KK, Pribitkin EA, Cowart BJ, Vainius AA, Klock CT, Rosen D, Hahn CG, Rawson NE. Smoking-associated squamous metaplasia in olfactory mucosa of patients with chronic rhinosinusitis. Toxicol Pathol 2009;37:594-8.

(5.) Matullionis DH. Ultrastructure of olfactory epithelia in mice after smoke exposure. Ann Otol Rhinol Laryngol 1974;83:192-201.

(6.) Brown CL, Graham SM. Nasal irrigations: good or bad? Curr Opin Otolaryn gol Head Neck Surg 2004;12:9-13.

Staffieri A (1), Marioni G (1), Staffieri C (1), Lionello M (1), Ottaviano G (1)

(1)Department Neurosciences. Section of Otolaryngology. University of Padova. Italy

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Title Annotation:Scientific Sessions: Health Benefit--Session 02; texto en ingles
Author:Staffieri, A.; Marioni, G.; Staffieri, C.; Lionello, M.; Ottaviano, G.
Publication:Anales de Hidrologia Medica
Date:Dec 1, 2012
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