Therapeutic Potential of Nigella sativa in Chronic Rhinosinusitis: A Narrative Review of Experimental and Clinical Evidence

Abstract

Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the nasal and paranasal sinus mucosa that significantly impairs quality of life. Although topical and systemic corticosteroids and endoscopic sinus surgery remain the standard of care, many patients still experience relapse and require repeated courses of treatment. Biologic therapies have shown promising outcomes; however, limited availability and high costs pose major barriers, particularly in low- and middle-income countries. Therefore, there is a need for an effective, safe, and affordable adjuvant treatment option. Nigella sativa, commonly known as black seed (alhabahat alsawda), contains bioactive compounds, notably thymoquinone, with antioxidant, anti-inflammatory, and immunomodulatory properties. This narrative review summarizes experimental and clinical evidence on Nigella sativa in CRS. In vitro studies suggest thymoquinone attenuates pro-inflammatory signaling, reduces fibroblast proliferation, and modulates epithelial barrier–related markers. In animal rhinosinusitis models, thymoquinone improves histopathology and decreases inflammatory cell infiltration. Limited clinical studies using nasal spray or oral extracts report improvements in validated symptom scores and quality-of-life measures with acceptable tolerability. Overall, Nigella sativa shows potential as an adjunctive therapeutic option in CRS, but the current evidence base is heterogeneous and small. Well-designed, adequately powered randomized controlled trials using standardized formulations, dosing regimens, and long-term follow-up are needed to confirm efficacy, safety, and clinical applicability.