What Is Chronic Rhinosinusitis
Chronic rhinosinusitis (CRS) is defined as inflammation of the paranasal sinuses and nasal cavity lasting more than 12 weeks, characterized by the presence of 2 or more of the following symptoms: nasal obstruction or congestion, anterior or posterior rhinorrhea, facial pain or pressure, and reduction or loss of smell (hyposmia or anosmia). The clinical diagnosis must be confirmed by nasal endoscopy or CT scan of the paranasal sinuses.
CRS is divided into two main phenotypes: with nasal polyps (CRSwNP) and without polyps (CRSsNP). This distinction has significant therapeutic implications — CRSwNP has a greater eosinophilic component, responds less to surgery, and benefits from anti-IL-4/13 biologics (dupilumab). Global prevalence is 10 to 15% of the adult population, with significant impact on quality of life, productivity, and sleep.
Conventional Treatments
CRS treatment is stepwise. Intranasal corticosteroids are the cornerstone of conservative management, while functional endoscopic sinus surgery (FESS) is reserved for cases refractory to medical treatment.
TREATMENTS FOR CHRONIC RHINOSINUSITIS
| INTERVENTION | INDICATION | CONSIDERATIONS |
|---|---|---|
| Intranasal corticosteroids | First line in all CRS | Fluticasone, mometasone; continuous use ≥8 weeks |
| Saline nasal irrigation (hypertonic solution) | Essential adjunct | Mucus removal and reduction of antigenic load |
| Low-dose macrolides (azithromycin) | Refractory CRSsNP | 3–6 months; anti-inflammatory effect, not antibiotic |
| Oral corticosteroids in short courses | CRSwNP with intense symptoms | Maximum 3 weeks; do not use chronically |
| FESS (endoscopic surgery) | CRS refractory to medical treatment | Improves drainage; recurrence in 40% at 2 years |
| Dupilumab (anti-IL-4/IL-13) | Severe CRSwNP refractory to surgery | Biologic; reduces polyp volume by 50% |
How Acupuncture Works in Chronic Sinusitis
The mechanistic hypotheses for acupuncture in CRS involve local and systemic effects: stimulation of perisinus nerves (branches of the trigeminal), possible modulation of the mucosal inflammatory response, and influence on nasal vascular tone — pathways described in experimental studies and still being consolidated in the clinical literature.
Mechanism of Action in Chronic Rhinosinusitis
LI-20 (Yingxiang) — Adjacent to the Infraorbital Nerve (V2)
Stimulation of the V2 branch of the trigeminal has been proposed as a pathway for activating perisinus afferent fibers, with possible reflex vasomotor effects on the nasal mucosa that would contribute to reduced edema and improved drainage. A plausible pathophysiological hypothesis.
BL-2 (Zanzhu) — Adjacent to the Supraorbital Branch (V1)
Stimulation in the topography of the supraorbital branch of the trigeminal V1 may contribute to symptomatic relief of pressure and pain in the forehead and glabella region, within the same trigeminal rationale.
ST-3 — Infraorbital Topography
Point adjacent to the V2 distribution area, in a position distal to LI-20. In clinical protocols, it is typically used to reinforce trigeminal stimulation in the maxillary region.
LI-4 — Systemic Modulation of Inflammation
Experimental studies suggest effects on mediators of the allergic response (such as IgE and eosinophils) and perisinus neuropeptides. Mechanism still partially elucidated.
LU-7 — Auxiliary Point in Respiratory Protocols
Classically associated with upper airway protocols. Some research suggests an effect on mucociliary transport — preliminary data that complements, without replacing, the better-documented pathways.
Scientific Evidence
RCT in CRSsNP — Adjunctive Acupuncture
Meta-analyses in CRS — General Overview
Modern Approach: Integrative Medical Acupuncture
CLINICAL PROTOCOL IN CRS
| PARAMETER | SPECIFICATION | NOTE |
|---|---|---|
| Main points | LI-20 + ST-3 + BL-2 bilateral | Perisinus trigeminal stimulation |
| Systemic points | LI-4 + LU-7 bilateral | Anti-inflammatory and respiratory modulation |
| Auxiliary point | GV-23 (associated allergic rhinitis) | Nose — central decongestion |
| Frequency | 2 sessions/week for 6–8 weeks | Induction phase |
| Maintenance | 1 session/month in stable CRS | Prevention of exacerbations |
| Post-FESS | Start 4 weeks after surgery | Reduces mucosal inflammatory recurrence |
When to See a Medical Acupuncturist
Ideal Profile
- CRS confirmed by CT or nasal endoscopy
- Partial response to intranasal corticosteroid
- Postoperative FESS — recurrence prevention
- CRS with anxiety/stress as a precipitating component
- Associated chronic headache and facial pressure
Investigate Before Starting
- CT of paranasal sinuses to confirm CRS
- Rule out neoplasia (unilateral, bleeding)
- Investigate septal deviation with obstructive impact
- Test for allergy if associated rhinitis
Frequently Asked Questions
Frequently Asked Questions
In cases of mild to moderate CRSsNP with response to conservative treatment, adjunctive acupuncture may prolong symptom control and reduce surgical urgency. In CRSwNP with bulky polyps or complications (mucocele, orbital invasion), surgery is necessary and should not be delayed.
In children, acupuncture requires adapted pediatric technique (finer needles, gentler stimulation, or alternatives such as laser and auriculotherapy with seeds/pellets). There are studies in children that suggest benefit on symptoms, but the volume of evidence is smaller than in adults. In younger children, non-invasive techniques such as shonishin (massage at the points) tend to be better tolerated. The decision must be individualized by the pediatrician and the medical acupuncturist.
There is no evidence of volumetric reduction of nasal polyps with acupuncture. It can relieve associated symptoms (obstruction, pressure), but treatment of polyps requires potent topical corticosteroids or biologics (dupilumab). Surgery (FESS) physically removes the polyps.
Typical clinical protocols involve 8 to 12 sessions over 6 to 8 weeks as an induction phase, with response evaluation by SNOT-22 and clinical parameters. In patients with long-standing CRS, monthly maintenance sessions may be considered. The exact number depends on individual response.
Yes, the combination is recommended. Intranasal corticosteroids act directly on mucosal inflammation, while acupuncture acts via a neural reflex pathway — complementary mechanisms with no known interactions.