Acute sinusitis
Also known as: acute sinusitis, acute rhinosinusitis, acute viral rhinosinusitis, acute bacterial rhinosinusitis, sinus infection
Acute sinusitis, more accurately termed acute rhinosinusitis, is a sudden inflammation of the nasal cavity and paranasal sinuses. It commonly follows a viral upper respiratory infection and causes nasal obstruction, nasal discharge, facial pain or pressure, reduced smell, headache, cough and sometimes fever or upper-tooth pain. Most cases are viral and improve without antibiotics. A bacterial cause becomes more likely when symptoms persist for more than approximately 10 days without improvement, are unusually severe, or worsen after initially beginning to improve. TCM differentiation commonly includes Wind-Heat invading the Lung, Wind-Cold obstructing the nasal passages, Lung and Stomach Heat, Liver and Gallbladder Damp-Heat, Phlegm-Heat obstructing the sinuses, or residual Spleen and Lung Qì deficiency with Dampness. Acupuncture and Chinese herbal medicine are adjunctive and must not delay assessment or treatment of orbital cellulitis, intracranial infection, severe systemic illness, invasive fungal disease, dental infection or another serious cause of facial pain.
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Lifestyle & Diet
- •Most acute sinus infections are viral and do not require antibiotics. A clinician should determine whether antibiotics are appropriate.
- •Symptoms lasting approximately 10 days or less generally do not justify routine antibiotics unless the patient is systemically very unwell or complications are suspected.
- •Use appropriate analgesia according to medical or pharmacy advice.
- •Maintain hydration according to thirst and clinical needs.
- •Saline nasal spray or irrigation may help some patients, but irrigation water must be sterile, distilled or previously boiled and cooled; equipment must be kept clean.
- •Do not use plain untreated tap water for nasal irrigation.
- •Avoid smoking, vaping and exposure to airborne irritants.
- •Rest according to symptoms while maintaining ordinary light activity as tolerated.
- •Avoid forceful nose blowing, particularly when facial pressure or ear symptoms are pronounced.
- •Topical nasal decongestants should not be used longer than directed because rebound congestion can occur.
- •Oral decongestants may be unsuitable in hypertension, cardiovascular disease, glaucoma, prostate disorders, pregnancy or with certain medicines; seek pharmacy or medical advice.
- •Intranasal corticosteroids may be considered in selected presentations according to clinical guidance, particularly when symptoms are prolonged or allergy is involved.
- •Do not use leftover or shared antibiotics.
- •Take prescribed antibiotics exactly as directed and seek advice if adverse effects occur.
- •Seek reassessment for worsening after initial improvement, symptoms persisting beyond the expected course, recurrent episodes or new visual, neurological or systemic symptoms.
- •Dental hygiene and dental review are important when maxillary sinus symptoms may originate from a tooth.
- •Avoid swimming or pressure-change activities when they markedly aggravate acute facial pressure or ear symptoms.
Cautions & Contraindications
- •Do not treat suspected orbital cellulitis, intracranial infection, invasive fungal sinusitis, sepsis or facial abscess with acupuncture or herbs alone.[,,]
- •Do not delay emergency referral for visual symptoms, proptosis, painful eye movement, marked periorbital swelling, neurological signs or altered consciousness.[,]
- •Do not needle deeply near the orbit, infraorbital foramen, nasal cavity or acutely infected facial tissue.[]
- •Do not insert unsterile liquids, herbal powders, essential oils or instruments into the nose.
- •Do not use untreated tap water for nasal irrigation.[]
- •Do not advise stopping prescribed antibiotics or corticosteroids without consulting the prescriber.[,]
- •Avoid prolonged topical nasal-decongestant use beyond product or clinician instructions because rebound congestion may occur.[]
- •Avoid Cāng Ěr Zǐ in excessive doses or prolonged courses because toxicity may occur.
- •Bàn Xià and Dǎn Nán Xīng must be correctly processed; raw forms are toxic.
- •Xìng Rén requires professional dosing because of cyanogenic toxicity risk.
- •Mù Tōng must be botanically verified and free of aristolochic acid.
- •Do not use prohibited, adulterated, contaminated or incorrectly identified herbal substances.
- •Screen herbal prescriptions for pregnancy, breastfeeding, age, weight, allergy, hepatic or renal impairment and interactions with antibiotics, anticoagulants, antihypertensives and other medicines.
- •Avoid strong warming formulas in fever, thick yellow discharge, thirst, facial heat or a red tongue with yellow coating.
- •Avoid strong bitter-cold formulas in a clearly Wind-Cold or markedly deficient presentation, especially with prolonged use.
- •Do not attribute persistent unilateral obstruction, bleeding, facial numbness or loss of smell indefinitely to Phlegm or Qì deficiency without medical investigation.[,]
- •Do not assume temporary symptom relief confirms that infection or complications have resolved.
- •Facial points near the orbit (BL2, ST1, ST2, GB14 and nearby extra points) and scalp points such as DU23 require precise superficial or anatomically appropriate technique, strict avoidance of the globe, and never directing a needle toward the orbit.[]
When to reassess or seek care again
- •Most viral cases resolve within 2–3 weeks; reassess at 10 days if symptoms are not improving or worsen after initial improvement (double-sickening).[,,]
- •Urgent review for periorbital swelling, visual change, severe unilateral headache, focal neurology, or high fever — assess for orbital/intracranial complications.[,,]
- •Reassess at 12 weeks if symptoms persist — reclassify as chronic rhinosinusitis and consider ENT referral, imaging, and allergy workup.[,]
- •Recurrent URTIs and allergic rhinitis.[,,]
- •Smoking, vaping, air pollution, and cold/damp exposure (Wind invasion, Damp-Heat).[,]
- •Structural factors — deviated septum, nasal polyps — and dental infections.[,]
Frequently Asked Questions
What is acute sinusitis?+
Acute sinusitis, or acute rhinosinusitis, is inflammation of the nasal cavity and paranasal sinuses causing congestion, discharge, facial pain or pressure and reduced smell. It commonly follows a viral cold [6].
Are most acute sinus infections bacterial?+
No. Most are viral and do not require antibiotics. Bacterial disease becomes more likely when symptoms persist beyond approximately 10 days without improvement, are unusually severe, or worsen after initial improvement [6].
Does green or yellow nasal mucus prove a bacterial infection?+
No. Coloured mucus may occur in viral or bacterial illness and should be interpreted together with symptom duration, severity and progression [6].
What are common TCM patterns for acute sinusitis?+
Common patterns include Wind-Heat invading the Lung, Wind-Cold obstructing the nasal passages, Lung and Stomach Heat, Liver-Gallbladder Damp-Heat, Phlegm-Heat and residual Spleen-Lung Qì deficiency with Dampness [6].
Which acupuncture points are commonly considered?+
Commonly considered points include LI20, Yintang, LI4, LU7, GB20, Bitong, BL2 and selected distal Heat- or Phlegm-clearing points. Facial and orbital-adjacent points require advanced anatomical care [6].
When does acute sinusitis require emergency care?+
Emergency assessment is required for visual loss, double vision, painful or restricted eye movement, proptosis, severe periorbital swelling, forehead swelling, severe frontal headache, neck stiffness, confusion, seizure or systemic deterioration [6].
Can acupuncture or herbs replace antibiotics?+
No. They may be used only as adjuncts. When bacterial sinusitis or a complication requires antimicrobial or surgical treatment, that care must not be delayed [6].
Is nasal irrigation safe?+
It can be safe when performed correctly, but only sterile, distilled or previously boiled and cooled water should be used. Untreated tap water should not be used [6].
When should persistent sinus symptoms be investigated?+
Symptoms lasting beyond the expected acute course, recurrent episodes, unilateral obstruction, bleeding, persistent loss of smell or symptoms extending beyond 12 weeks require further assessment [6].
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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.
- National Institute for Health and Care Excellence · 2023
Diagnosis, expected course, delayed or immediate antibiotic considerations, complications and reassessment for acute rhinosinusitis.
- Infectious Diseases Society of America (Clinical Infectious Diseases) · 2012
Diagnostic features suggesting bacterial rhinosinusitis and principles of antibiotic stewardship.
- US Centers for Disease Control and Prevention · 2024
Symptoms, typical causes, safe nasal-irrigation water advice and that many sinus infections do not require antibiotics.
- Healthdirect Australia · 2026
Australian information on symptoms, complications, treatment and circumstances requiring medical care.
- Royal Australian College of General Practitioners (AJGP) · 2016
Australian primary-care review of diagnosis, differential diagnosis, dental and structural considerations and management of acute rhinosinusitis.
- World Health Organization · 2008
Standardised nomenclature and anatomical location methodology for acupuncture points.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.