Chronic rhinosinusitis

Chronic rhinosinusitis is inflammation of the lining of the nose and the paranasal sinuses, the air spaces in the bones of the face, that lasts 12 weeks or more. The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) defines it in adults as two or more symptoms for at least 12 weeks, one of which must be a blocked nose or nasal discharge, with facial pain or pressure and a reduced or lost sense of smell as the others; it occurs with or without nasal polyps, soft swellings of the sinus lining. The literature on acupuncture for it is small next to the one on hay fever and year-round allergy, which Allergic rhinitis covers: one systematic review of 10 trials, one trial with a sham arm, and two small studies that measured nasal congestion within half an hour of needling. EPOS 2020 advises against acupuncture for chronic rhinosinusitis, and the American guideline on adult sinusitis, updated in 2025, does not mention it.

Is there a Cochrane review?

No. A PubMed search of the Cochrane Database of Systematic Reviews on 14 October 2026 found no Cochrane review of acupuncture for sinusitis or nasal congestion; Cochrane’s reviews of chronic rhinosinusitis cover saline irrigation, steroids, antibiotics, antifungals, biologic drugs and surgery. The most recent systematic review is the one below.

What the systematic review found

The 2022 systematic review by Lee, Kwon and Park, published in August 2022 with searches of 14 English, Korean, Chinese and Japanese databases to April 2022, included 10 randomised trials published between 2005 and 2022, nine from China and one from Norway. Its own table lists 1,461 people enrolled, 687 of them in one moxibustion trial. Five trials used manual acupuncture, two electroacupuncture, two moxibustion, which burns mugwort above the skin, here on a slice of ginger, and one transcutaneous electrical acupoint stimulation, current passed through skin pads. The points used most often were LI04 (Hegu) on the hand, in 6 trials, then LI20 (Yingxiang) beside the nostril and XH03 (Yintang) between the eyebrows, written EX-HN3 in the review, in 5 each, and GV20 (Baihui) on the crown in 3. Two trials needled ST07 (Xiaguan) in front of the ear deeply, one of them aiming at the pterygopalatine ganglion, a cluster of nerve cells behind the cheekbone. The review kept its comparisons apart:

No trial reported how allocation was concealed or whether participants, practitioners or outcome assessors were blinded. Four of the ten trials studied pain or anaesthetic dose around endoscopic sinus surgery rather than the long-term disease. The adverse events reported were one mild fever after manual acupuncture, one haematoma after electroacupuncture, and small bleeds, nerve pain and dizziness in the sham trial. The authors rated the evidence moderate to low, wrote that the clinical heterogeneity of the trials called for rigorous, well-designed trials to confirm the findings, and noted that no trial varied its treatment by whether the patient had nasal polyps.

A 2020 systematic review by Wu and colleagues, which put more than 60 alternative therapies for sinusitis and rhinitis to a panel of rhinologists through a modified Delphi process, a series of rounds that ends in a consensus, found acupuncture among four with low to moderate-high GRADE ratings, beside capsaicin, bromelain and butterbur extract. Allergic rhinitis was the condition most studied, and the panel found comparisons with standard therapies lacking.

The sham-controlled trial

The trial by Rössberg and colleagues, published in 2005, recruited 65 people with sinus symptoms for more than 3 months and signs of sinusitis on computed tomography (CT) at an outpatient specialist clinic, and randomised them to three arms: 2 to 4 weeks of antibiotics, corticosteroids, saline and decongestant nose drops (21 people); 10 sessions of traditional Chinese acupuncture (25); or 10 sessions of minimal acupuncture at non-acupuncture points (19). The trial was single-blind. Swelling of the sinus lining on CT fell over 4 weeks in the conventional group alone, and quality of life improved over 12 weeks in that group alone. The difference in symptom score change between conventional treatment and sham had a p value of 0.06, short of the usual 0.05 threshold, and the difference between conventional treatment and real acupuncture was not significant either. Lee 2022 lists the points as chosen by a traditional Chinese diagnosis of each patient, with LI04 in every pattern.

The same group’s 2008 report of the trial’s quality-of-life outcomes, by Stavem and colleagues, found no difference on any scale between real and minimal acupuncture. Conventional treatment improved more than sham on the role-physical scale of the SF-36, a general health questionnaire (p = 0.02), and more than real acupuncture on its mental health scale (p = 0.03). The authors found no clear evidence that any of the three treatments was superior on short-term quality of life. EPOS 2020 adds that 15 participants had sinus surgery within 12 months: 5 from the conventional group, 6 from acupuncture and 4 from sham.

Nasal congestion measured in minutes

Two small randomised studies with Sertel and Plinkert among the authors measured airflow through the nose before and shortly after one session.

• 2009, against control points. The pilot study by Sertel and colleagues treated 24 people with nasal congestion from enlarged inferior turbinates, the ridges of swelling-prone lining inside each nostril, or from chronic sinusitis without polyps, at points chosen by a traditional Chinese diagnosis or at non-specific control points, with the acupuncturist blinded. Congestion was scored on a visual analogue scale and airflow measured by rhinomanometry 15 and 30 minutes after needling. Control needling improved the congestion score while airflow fell; real acupuncture improved both. The authors concluded that the two measures can register an effect of acupuncture in the living nose.
• 2015, against sham points. The study by Albrecht and colleagues treated 25 people with enlarged inferior turbinates and recorded swelling of the turbinate lining continuously for 20 minutes by optical rhinometry, which measures light passing through the nose. Sham needling improved the congestion score while the instrument recorded more swelling. Real acupuncture acted sooner on nasal blood flow, but the measurement could not show a decongestant effect, and the authors reported that the sham worked better than they had expected.

Sham acupuncture sets out what minimal needling and control points can and cannot rule out.

What guidelines say

EPOS 2020, by Fokkens and colleagues and published in February 2020 as a supplement to the journal Rhinology, found two reports from the same Norwegian group and rated the evidence at level 1b. It concludes there is no evidence that traditional Chinese medicine or acupuncture is more effective than placebo for chronic rhinosinusitis, notes that minor and serious adverse events can occur with acupuncture and related methods, and states that its steering group advises against both. EPOS 2020 has not been replaced: the one update since, the 2023 EPOS/EUFOREA update by Fokkens and colleagues, revises only the use of biologic drugs in chronic rhinosinusitis with nasal polyps, and AcuiQ found no later edition in Europe PMC by October 2026.

The American Academy of Otolaryngology–Head and Neck Surgery Foundation’s 2015 adult sinusitis guideline, by Rosenfeld and colleagues, does not mention acupuncture or any other complementary therapy. Its August 2025 update, by Payne and colleagues, which makes 14 recommendations on diagnosis, testing and treatment, does not mention acupuncture either. Clinical guidelines sets out other bodies’ positions on acupuncture, and Moxibustion describes the method behind the review’s largest trials.

What the reviews could not settle

Whether real acupuncture differs from sham in chronic rhinosinusitis rests on one trial of 44 people in its two needling arms, and the 2022 review found no comparison between them to report. The pooled results against conventional treatment come from unblinded trials scored on a response rate each trial defined for itself, held only for moxibustion under sensitivity analysis, and mix trials of the disease with trials of pain after surgery; for one of the ten, the review’s reference list cites a paper on a rice fungus, so that trial cannot be traced from the review. No trial tested acupuncture separately in people with and without nasal polyps, and the two congestion studies measured effects over 20 to 30 minutes. EPOS 2020 predates the 2022 review, and neither American guideline addresses acupuncture.

AcuiQ’s chronic sinusitis, rhinosinusitis and nasal congestion pages list the protocols individual studies prescribed, each with its citation.