Chronic Sinusitis

What is Chronic Sinusitis?

Chronic sinusitis, also called chronic rhinosinusitis, is inflammation of the lining of the nose and the air spaces around it (the paranasal sinuses) that lasts 12 weeks or longer.^{[1, 2]} It is diagnosed from a combination of symptoms and findings on nasal endoscopy or imaging, and it affects roughly 5% of the population.^[2]

Common symptoms

The main symptoms are a blocked nose, nasal discharge, facial pain or pressure and a reduced sense of smell.^[3] Facial pain and loss of smell are the symptoms that most clearly separate chronic sinusitis from other nose problems.^[4]

Causes and risk factors

Chronic sinusitis is not one disease with one cause. It is a group of conditions with persistent inflammation of the nasal lining, and it is divided into forms with and without nasal polyps.^[4] Researchers have linked it to a damaged mucosal barrier, immune activity (including eosinophils), and the bacterium Staphylococcus aureus.^[4]

It often occurs together with asthma, in about 20% to 45% of cases.^[2]

How it is diagnosed and treated conventionally

A doctor, often an ear, nose and throat specialist, diagnoses chronic sinusitis from your symptoms plus nasal endoscopy and imaging.^[2] Treatment is mainly medical: steroid nasal sprays, nasal saline rinses and, in some cases, steroid tablets or antibiotics.^[2]

If medicines do not give lasting relief, endoscopic sinus surgery is an option, and biologic medicines are used for severe disease with nasal polyps.^{[2, 4]} Large-volume saline irrigation has some support, but a Cochrane review of only two small trials rated the evidence as low to very low quality.^[3]

Why Chronic Sinusitis calls for a whole-person approach

Chronic sinusitis is more than a local blockage. It involves the immune system, the airways below the nose, sleep and mood, and these can feed back on one another.

Care that pays attention to these linked factors is a reasonable addition to treatment aimed at the sinuses. The studies below describe links, and they do not show that treating one factor fixes another.

Inflammation and the nasal lining

Persistent inflammation of the nasal lining, not just infection, drives the condition.^[4] This is why steroid nasal sprays are the main medical treatment.^[2]

Asthma and other conditions

Chronic sinusitis is linked with a higher risk of several other conditions, including asthma, chronic obstructive pulmonary disease and obstructive sleep apnea.^[2] Your physician should know about all of them.

Sleep and fatigue

Poor sleep and fatigue are common. A meta-analysis of 16 studies found that treating chronic sinusitis was followed by better reported sleep quality and less fatigue, although objective sleep measurements did not change.^[5]

Stress, mood and quality of life

A meta-analysis of 32 studies found depression symptoms in about 25% and anxiety symptoms in about 30% of people with chronic sinusitis.^[6] The disease also markedly lowers quality of life.^[2] Mood and stress are therefore worth addressing alongside the nose.

Acupuncture for Chronic Sinusitis

What the research shows

Acupuncture for chronic sinusitis has been tested in only a few small trials, and the evidence is limited. In a three-arm trial of 65 people with CT-confirmed sinusitis, 10 sessions of traditional acupuncture were compared with minimal acupuncture at non-acupuncture points and with conventional medicines. Sinus swelling on CT and quality of life improved in the medicine group. The difference in symptom scores between real acupuncture and conventional treatment was not statistically significant, which does not show that the two work equally well.^[7]

A small double-blind pilot trial of 24 people with nasal congestion from enlarged turbinates or chronic sinusitis found that acupuncture at points chosen by traditional diagnosis improved congestion scores and nasal airflow over 30 minutes, whereas acupuncture at control points improved congestion scores but worsened airflow. This measured only a short-term effect, and the study was small and included people with enlarged turbinates as well as chronic sinusitis.^[8]

A review that graded complementary therapies for sinusitis and rhinitis, mostly studied in allergic rhinitis, gave acupuncture a low to moderate-high rating, while noting that most alternative therapies have little scientific support.^[9]

How acupuncture may work

Researchers have not established how acupuncture might affect chronic sinus inflammation. The pilot trial above measured a short-term rise in nasal airflow after treatment, but it did not test why.^[8] We therefore describe acupuncture here as a way to support comfort and breathing, not as a treatment for the underlying inflammation.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the face, head, hands and legs, usually left in place for about 20 to 40 minutes. The trial of 65 people used 10 treatments, and we reassess after a short course of visits.^[7]

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Chronic Sinusitis

The Ayurvedic view

Ayurveda describes long-standing sinus disease under the name Dushta Pratishyaya, the chronic stage of Pratishyaya, a nasal condition.^[11] In this traditional framework, it is linked to Kapha, the principle associated with moisture and heaviness, sometimes combined with Vata or Pitta. These are traditional categories for choosing treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to reduce Kapha, such as warm, lightly spiced meals
• Herbal preparations taken by mouth, and steam inhalation^[12]
• Nasya, the placing of herbal powders or medicated oil in the nose, a Panchakarma therapy that was used in a small clinical study of chronic sinusitis^{[11, 12]}

Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty. Nasal therapies should wait until a physician has ruled out an acute infection or other serious cause.

What the research shows

The research on Ayurveda for chronic sinusitis is limited. A systematic review found 13 studies of Ayurvedic treatment for chronic sinusitis. All reported improvement, but all had a significant risk of bias from their design and statistics, so the authors could not make a recommendation and called for well-designed controlled trials.^[12]

One small study randomized 37 patients to an oral decoction, nasya, or both, and 31 completed it. Marked improvement was reported in about 82% of the nasya group and 60% of the combined group, while complete relief occurred in 10% of the decoction-only group. The study had no placebo group.^[11]

Herbal medicine for Chronic Sinusitis

Herbs and formulas that have been studied

Trials have tested Chinese formulas such as Lianhuaqingwen granules and a combination of Tsang-Erh-San and Houttuynia extracts.^{[13, 14]} A European plant extract studied is Sinupret extract.^[15] Herbs vary in how they are prepared, and a qualified practitioner prescribes them individually.

What the research shows

The evidence is limited and mixed. In a placebo-controlled trial of 140 people with chronic sinusitis without polyps, Lianhuaqingwen granules lowered symptom scores over one month compared with placebo.^[13] Other results were less clear. In 929 people, Sinupret extract did not beat placebo on the main outcome, although the authors reported a benefit in a post-hoc subgroup.^[15] A Chinese herbal formula worked about as well as erythromycin in 53 people, and the authors noted that a placebo effect was possible.^[14] After sinus surgery, the same formula showed no significant benefit over placebo or amoxicillin.^[16]

A network meta-analysis of 47 trials rated the evidence for most herbal medicines in chronic sinusitis as low certainty and limited to few studies.^[17] A 2025 review of traditional Chinese medicine noted benefits after surgery but is a narrative review, not a systematic one.^[18]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dan shen, dang gui, ginger, ginseng and Boswellia.^[19] Adverse events were a concern with some herbal products in the network meta-analysis.^[17]

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, take steroids or other long-term medicines, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine classifies chronic sinusitis as Bi Yuan and attributes it to causes such as wind, damp-heat and qi and blood stasis.^[18] Researchers studying herbs and traditional formulas look at things that loosely parallel this picture: inflammatory mediators, mucosal healing, bacterial biofilms and clearance of mucus.^{[13, 18]}

Ayurveda's excess Kapha describes congestion and heaviness. No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for chronic sinusitis is complementary. Keep your primary care physician or ENT specialist, and do not stop or change prescribed sprays, steroids, antibiotics or biologic medicines without your prescriber. We do not diagnose the cause of sinus symptoms, so symptoms that last or keep returning need medical evaluation.

Please bring your diagnosis, any CT or endoscopy reports, a full list of medicines and supplements, and details of any sinus surgery, planned or past.

When to seek urgent medical care

Rarely, a sinus infection spreads to the eye socket or brain, and some symptoms need prompt assessment.

• Swelling, redness or pain around an eye, or vision changes or double vision
• Severe headache, stiff neck, confusion or drowsiness
• High fever with worsening facial pain
• Swelling of the forehead or face
• Symptoms on only one side with nosebleeds or a blocked nostril that does not clear

If any of these occur, call 911 or go to the nearest emergency department.