Chronic Sinusitis (Chronic Rhinosinusitis)
Also known as: Chronic sinusitis, Chronic rhinosinusitis, CRS, Chronic rhinosinusitis with nasal polyps, CRSwNP, Chronic rhinosinusitis without nasal polyps, CRSsNP, Chronic sinonasal inflammation, Recurrent sinonasal disease
Chronic rhinosinusitis is persistent inflammation of the nasal and paranasal sinus mucosa, generally defined by compatible symptoms lasting at least 12 weeks together with objective evidence of sinonasal inflammation. Typical symptoms include nasal obstruction or congestion, anterior or posterior nasal discharge, reduction or loss of smell, and facial pressure or discomfort. It is commonly classified as disease with nasal polyps (CRSwNP) or without polyps (CRSsNP), although modern classification increasingly recognises distinct inflammatory endotypes. Associated conditions include asthma, allergic rhinitis, aspirin-exacerbated respiratory disease, immunodeficiency, dental disease, structural obstruction and selected fungal disorders. Diagnosis should not rest on facial pain alone and may require nasal examination, endoscopy or CT imaging. First-line medical management commonly includes regular saline nasal irrigation and intranasal corticosteroid therapy; antibiotics are not routinely indicated for uncomplicated chronic inflammatory disease unless bacterial infection is specifically suspected. Persistent or severe disease may need ENT assessment, additional pharmacological management, biologic therapy in selected severe nasal-polyp disease, or endoscopic sinus surgery [1][2][3][4][5]. In Chinese medicine, chronic rhinosinusitis overlaps with Bí Yuān 鼻渊, Bí Zhì 鼻窒 and Bí Sāi 鼻塞, involving the Lung, Spleen and channels of the face. Common mechanisms include lingering Wind-Heat obstructing the nasal passages, Damp-Heat accumulating in the sinus region, Phlegm-Damp obstruction with Spleen Qi deficiency, Lung Qi deficiency with impaired dispersing and descending, Qi and Blood stasis obstructing the nasal collaterals, and constitutional Lung-Spleen deficiency with recurrent disease. Pattern differentiation must be integrated with examination for polyps, infection, allergic disease, dental pathology, asthma and structural obstruction. Acupuncture is adjunctive and does not replace intranasal corticosteroids, saline irrigation, appropriate antimicrobial treatment, ENT assessment or surgery when medically indicated [1][2][6].
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Lifestyle & Diet
- •Use regular saline nasal irrigation when clinically appropriate, with sterile, distilled or previously boiled and cooled water — never untreated tap water.
- •Clean irrigation devices according to the manufacturer's instructions and use an appropriate saline concentration.
- •Stop irrigation and seek advice if it causes significant pain, persistent ear symptoms or bleeding.
- •Use prescribed intranasal corticosteroid therapy consistently and with correct spray technique.
- •Follow ENT or medical recommendations for nasal polyps and persistent disease.
- •Avoid tobacco smoke, vaping and inhaled irritants, including workplace dust, smoke and chemical exposure.
- •Manage coexisting allergic rhinitis and asthma appropriately and reduce exposure to identified allergens where practical.
- •Address mould or damp environmental exposure and avoid excessive fragrances or irritant aerosols indoors.
- •Maintain adequate hydration.
- •Seek dental assessment when odontogenic sinusitis is suspected.
- •Avoid prolonged unsupervised use of topical nasal decongestants because rebound congestion may occur.
- •Do not self-start leftover antibiotics for chronic symptoms.
- •Monitor changes in nasal obstruction, smell, discharge and facial symptoms, and seek review for persistent unilateral symptoms, recurrent bleeding or a substantial change in symptom pattern.
Cautions & Contraindications
- •Do not use acupuncture in place of emergency assessment for orbital or neurological symptoms — complicated sinus infection can spread to orbital or intracranial structures.
- •Do not needle deeply or in a superior direction around the orbit; risk of ocular, vascular and other tissue injury.
- •Do not needle through acutely infected facial skin because of the risk of spreading infection.
- •Do not use herbal medicine as a substitute for indicated antibiotics; coordinate with medical care.
- •Do not recommend routine antibiotics for chronic rhinosinusitis without evidence of bacterial infection — unnecessary use causes adverse effects and antimicrobial resistance, and antibiotic decisions belong within medical assessment.
- •Do not advise stopping prescribed intranasal corticosteroids because acupuncture has commenced; medicine changes must be discussed with the prescribing clinician.
- •Do not use strong Blood-moving herbs around planned sinus surgery because of perioperative bleeding risk; review herbal products with the surgeon before surgery.
- •Do not use restricted or high-risk herbal ingredients — exclude Má Huáng, Fù Zǐ, Xì Xīn and Aristolochia species from Medi-Chi recommendations.
- •Do not claim that acupuncture cures chronic rhinosinusitis or permanently removes nasal polyps; describe acupuncture as adjunctive care without guarantees of outcome [6].
When to reassess or seek care again
- •Initial: confirm that compatible symptoms have persisted for at least 12 weeks before working with a chronic rhinosinusitis diagnosis.
- •Initial: document nasal obstruction, nasal discharge, postnasal drainage, smell disturbance and facial symptoms.
- •Initial: review previous nasal endoscopy, CT imaging and ENT diagnoses where available, and clarify whether nasal polyps are present.
- •Initial: assess allergic rhinitis, asthma and aspirin or NSAID sensitivity.
- •Initial: review smoking, vaping and occupational exposures.
- •Initial: ask about dental disease or procedures associated with unilateral maxillary symptoms.
- •Initial: reconcile intranasal corticosteroids, saline irrigation, antibiotics, antihistamines and other treatments.
- •Initial: screen for unilateral bleeding, visual symptoms, neurological symptoms, fever and facial swelling.
- •Ongoing: track nasal obstruction, discharge and smell function at each review.
- •Ongoing: record the frequency and severity of exacerbations.
- •Ongoing: monitor treatment adherence and nasal spray technique.
- •Ongoing: screen for new unilateral or red-flag features at every visit.
- •Ongoing: review changes in asthma or allergic disease control.
- •Ongoing: assess treatment tolerance and local bruising after facial acupuncture.
- •Ongoing: coordinate ENT review when symptoms persist despite an appropriate management trial.
- •Ongoing: reassess the diagnosis when facial pain persists without characteristic sinonasal symptoms or objective evidence of sinus disease.
- •Outcome measures: Sino-Nasal Outcome Test-22 (SNOT-22), visual analogue scale for overall sinonasal symptom severity, nasal obstruction severity, patient-reported smell function, exacerbation frequency, rescue medicine use, sleep disturbance, and the Patient-Specific Functional Scale where appropriate.
Frequently Asked Questions
What counts as chronic rhinosinusitis?+
Compatible sinonasal symptoms — nasal obstruction, nasal or postnasal discharge, reduced smell, facial pressure — lasting at least 12 weeks with objective evidence of sinonasal inflammation on examination, endoscopy or CT. Facial pain alone is not enough to make the diagnosis [1][2].
Can acupuncture replace a corticosteroid nasal spray?+
No. Saline irrigation and intranasal corticosteroids remain first-line medical management. Acupuncture may be used adjunctively for symptom support, and patients should not stop prescribed sprays because they have started acupuncture [1][2][6].
Which TCM patterns are most common in chronic sinusitis?+
Lingering Wind-Heat, Damp-Heat in the sinus region, Spleen Qi deficiency with Phlegm-Damp, Lung Qi deficiency, Qi and Blood stasis in the nasal collaterals, and combined Lung-Spleen Qi deficiency. Chronic cases usually mix excess and deficiency mechanisms.
When should a patient be referred urgently?+
Immediately for orbital swelling, visual change, painful eye movement, severe headache with neurological signs, neck stiffness or sepsis. Urgently for unilateral obstruction, blood-stained or foul discharge, repeated epistaxis, facial numbness, or necrotic nasal tissue in an immunocompromised or diabetic patient [1][2].
Is facial needling safe around the sinuses?+
With conservative depth and angle, yes. Never needle deeply or superiorly near the orbit, avoid infected skin, warn about bruising, and take extra care with anticoagulant therapy.
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- American Academy of Otolaryngology–Head and Neck Surgery Foundation · 2026
Diagnostic criteria, antibiotic stewardship and management principles for adult sinusitis.
- European Rhinologic Society · 2020
International consensus on classification, endotypes, medical management and surgical indications in chronic rhinosinusitis.
- Healthdirect Australia · 2026
Australian public health guidance on sinusitis symptoms, self-care and when to seek help.
- American Academy of Otolaryngology–Head and Neck Surgery Foundation · 2026
Indications, perioperative considerations and outcomes for endoscopic sinus surgery.
- Healthdirect Australia · 2026
Australian patient-facing information on endoscopic sinus surgery.
- Australian Health Practitioner Regulation Agency · 2026
Advertising and claims obligations for registered Australian practitioners.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.