Chronic rhinosinusitis is a long-term inflammation of the nasal and paranasal sinus mucosa lasting twelve weeks or more, characterized by at least two of the following symptoms: nasal congestion, facial pressure or pain, reduced sense of smell, and/or nasal discharge. It’s estimated that about 1 in 10 adults worldwide are affected, though prevalence may be higher in some regions due to genetic, cultural, and environmental factors that contribute to persistent inflammation of the nasal and sinus lining.

Contributing factors can include allergic or environmental irritants—from household allergens to air pollution—structural issues such as a deviated nasal septum, enlarged turbinates, or nasal polyps that obstruct sinus drainage, recurrent infections, immune dysfunction, asthma, and even gastroesophageal reflux. It’s highly likely that two or more of these are present in a patient, making each case somewhat unique and often requiring a tailored, multidisciplinary approach to resolve symptoms.

Standard treatment usually starts with intranasal corticosteroids and nasal saline irrigation, with the option of adding antibiotics, systemic steroids, antihistamines, decongestants, or leukotriene modifiers. The data show that up to 90% of chronic rhinosinusitis patients without nasal polyps respond to this approach, though the success rate falls to 50–70% in the presence of nasal polyps. For the 10–20% who don’t respond to conventional treatment, the patient may receive referral to see if they are a candidate for functional endoscopic sinus surgery aimed at enlarging the sinuses to restore proper drainage and ventilation.

For patients who don’t tolerate certain medications, wish to avoid surgery, or continue to experience symptoms even after undergoing functional endoscopic sinus surgery, there is limited evidence that some hands-on therapies provided by chiropractors may be of benefit. A 2024 systematic review reported that manual therapies—including cervical soft tissue manipulation, cervical myofascial release, cervical high-velocity/low-amplitude thrust manipulation (HVLA-TM), thoracic muscle energy, scapular release, thoracic HVLA-TM, cranial techniques, and lymphatic drainage—may help reduce head and neck congestion, improve lymphatic and venous outflow, normalize autonomic tone, enhance respiratory mechanics and immune function, and decrease perceived facial pressure and headache.

While chiropractors in most jurisdictions are recognized as portal-of-entry healthcare providers—meaning patients can see them directly without referral—chronic rhinosinusitis may, in some regions, fall outside the direct chiropractic scope of practice. In such cases, co-management with the patient’s physician is advised, and chiropractic care should be provided on an adjunctive basis consistent with local regulations.