Question 1

What counts as chronic rhinosinusitis?

Accepted Answer

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].

Question 2

Can acupuncture replace a corticosteroid nasal spray?

Accepted Answer

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].

Question 3

Which TCM patterns are most common in chronic sinusitis?

Accepted Answer

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.

Question 4

When should a patient be referred urgently?

Accepted Answer

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].

Question 5

Is facial needling safe around the sinuses?

Accepted Answer

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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