Background: Chronic sinusitis is an inflammatory condition of the paranasal sinuses persisting for more than twelve weeks, marked by nasal congestion, mucopurulent discharge, facial pain, and anosmia. Its global prevalence and the growing limitations of conventional pharmacotherapy—particularly antibiotic resistance and steroid-related adverse effects—have renewed scholarly interest in traditional systems of medicine. Shalakya Tantra, the Ayurvedic speciality dedicated to diseases of the head and sense organs (Urdhvanga), offers a comprehensive and time-tested framework for understanding and treating this condition.

Objective: To critically review the classical Ayurvedic conceptualisation of chronic sinusitis, its correlation with Dushta Pratishyaya and Kaphaja Shiroroga, and to systematically evaluate the therapeutic measures described under Shalakya Tantra for its effective management.

Methods: A comprehensive review of classical Ayurvedic texts including Charaka Samhita, Sushruta Samhita, Ashtanga Hridayam, Ashtanga Sangraha, Madhava Nidana, and Sharangadhara Samhita was undertaken. Published clinical studies, single-arm trials, and case reports from peer-reviewed Ayurvedic journals between 2000 and 2024 were also analysed to correlate classical perspectives with contemporary clinical evidence.

Results: Classical texts systematically describe the pathology of chronic sinusitis under Pratishyaya (rhinitis/sinusitis) and its chronic, complicated form as Dushta Pratishyaya, with Kaphaja predominance being most analogous to chronic sinusitis. The Shalakya Tantra approach employs a multi-modal treatment strategy comprising Nasya karma (nasal drug instillation), Dhumapana (medicated fumigation), Kavala-Gandusha (oil gargling), Shirobasti, Shiroabhyanga, and a range of internal medicines. Among these, Pratimarsha Nasya with Anu Taila and Shadbindu Taila has demonstrated consistent clinical efficacy in reducing mucosal oedema, improving mucociliary clearance, and relieving pain.

Conclusion: Ayurvedic management through the Shalakya Tantra paradigm offers a holistic, dosha-specific, and patient-centred approach to chronic sinusitis. Integration of classical Panchakarma procedures, herbal pharmacotherapy, and dietetic regulation demonstrates therapeutic potential that merits well-designed randomised controlled trials for further validation.