Chronic Sinusitis, Environmental Triggers, and Achieving Lasting Relief
In my almost 40-year career as an Ear, Nose, and Throat (ENT) Surgeon, I have treated over 30,000 patients with chronic sinusitis. During that time, I developed a safe, effective sinus protocol that anyone can easily use to gain sinus symptom relief. That protocol is based on information from the groundbreaking 1999 Mayo Clinic study finding that over 93% of chronic sinusitis cases are caused by an immune reaction fungi.
Focusing on the mold/fungus trigger moved the needle dramatically for my chronic sinusitis patients, unlike the repetitive antibiotic and steroid treatment that only offered temporary relief. In fact, when I addressed fungus and environmental mold as the underlying cause of most chronic sinusitis, I was able to help more and more patients recover without surgical intervention. When a patient removed mold exposures (both the environmental exposure and the mold/mycotoxins from the sinuses and body), their sinusitis would improve dramatically along with their overall health and wellbeing. As a matter of fact, the genesis of this very website was based on my desire to share as much of these findings and clinical knowledge about mold and sinusitis with anyone out there looking for help and guidance for better treatment and lasting relief.
Because chronic rhinosinusitis (CRS) affects approximately 37 million Americans, or 1 in 6 (16.3%) and is more common than arthritis (12.47%), orthopedic impairment (12.14%), or hypertension (11.44%),1 I wanted to revisit the basics by answering some of the most common sinusitis questions to help anyone out there still suffering to come up with a better plan to end the cycle of suffering and get the relief you deserve.
What is Chronic Sinusitis?
To meet the clinical definition of chronic rhinosinusitis (CRS), cases should meet the following criteria:
– A diagnosis of CRS based on patient history;
– An abnormal endoscopic sinus exam and abnormal sinus CT scan;
– Symptoms that are present for at least 3 months and include 2 or more of the following:
(a) facial pain or pressure,
(b) facial congestion or fullness,
(c) nasal obstruction or blockage,
(d) nasal discharge/purulence/discoloration,
(e) postnasal drainage, or (f) hyposmia/anosmia (loss of some or all smell).
Sinusitis must be present for at least 3 months and been treated with antibiotics for 4–6 weeks (or 4 or more sinusitis episodes per year treated with antibiotics for 7–10 days each), with symptoms persisting or recurring after cessation of antibiotic treatment.
How Do You Know if Sinusitis is Caused by Mold/Fungus?
Mayo Clinic found that 93% of patients with CRS met the diagnostic criteria for Allergic Fungal Sinusitis (AFS) or sinusitis caused by an allergic reaction to mold/fungus. It was then postulated that an immune reaction to fungus in the sinus mucosa is likely responsible for AFS and most CRS. This fact was confirmed by Braun et al in 2003. In addition, immunoglobulin IgE mediated hypersensitivity (mold allergy) was NOT present in the majority of cases studied, regardless of whether nasal polyps were present. So, while IgE antibodies to fungus are present in about 10% of patients with CRS, about 90% of CRS patients have positive IgG antibodies to fungi. IgG antibodies indicate a delayed allergic reaction to the fungus. IgG antibodies are primarily involved in fighting against pathogenic viral, bacterial, and fungal strains and are produced in response to specific antigens present in those pathogens. This indicates a sickness response rather than a typical allergic response to mold. In CRS the nasal mucous contains eosinophils (white blood cells), Charcot-Leyden crystals (an indication of an immune response to an infection), IgG fungal antibodies, no helper T- Lymphocytes (an indication of chronic rather than acute immune response), and no antigen processing cells (without antigen processing cells, adaptive immunity cannot take place and the person will continue to be sick without removing the antigen). Peripheral blood of CRS patients contains fungal specific elevated IgG and fungal antigens indicating past or present infection.
Can Sinusitis Still Be Mold-Related if a Person Does NOT Have a Mold Allergy?
Only 10 % of CRS patients have an immediate IgE allergy or skin test reaction to mold, while 90% have a delayed IgG reaction. So unless the testing includes blood levels of IgG antibodies for molds, an allergy will not likely show up. This includes a skin test that indicates an immediate IgE reaction which is negative in 90% of these patients. Additionally, allergy shots for mold will not alleviate CRS. The immune response is more like the response to constant exposure to a virus or bacteria that your body mounts a defense against but just cannot get rid of or gain immunity to. Thus, even with allergy shots to decrease an IgE reaction to the mold, with chronic sinusitis, the IgG immune response continues creating a constant inflammatory response which can lead to immunocompromise, infection, and eventually autoimmunity and disease.
Why Don’t Antibiotics Work for Chronic Sinusitis?
Antibiotics do not work long term for CRS because the cause of the bacterial infection is from the eosinophil (white blood cells) attacking the fungus in the sinus mucosa and releasing major basic protein which kills the fungus but causes pitting in the mucosal lining. The pitting destroys the cilia (tiny, hair-like structures that are free-floating in the nose and sinus cavity), mucous pools and gets stuck in the pits, and grows bacteria. Antibiotics temporarily stop bacterial growth but resistant strains eventually occur. Additionally, the fungus/eosinophil immune reaction continues making pits in the mucosal lining and destroying the cilia which makes the mucous pool in the pits and grow bacteria. Thus, the sinus infections continue until the fungus is removed from both the patient’s air and sinuses. If the fungus is never addressed, the cycle of infection will just continue.
Why is Nasal Irrigation Important? And Why Twice a Day?
Nasal irrigation is very important with both saline and CitriDrops Dietary Supplement added to saline because removal of the mold antigen using a natural antimicrobial is the fastest way to stop the immune reaction that causes the mucosal pit formation to stop CRS. Irrigating twice per day is ideal to keep the sinus mucosa free of mold and other allergens. CitriDrops Nasal Spray can also be used to make the mucosa antifungal to protect against mold exposures.
What Can Be Done for Lasting Relief?
The obvious and most important piece of the puzzle is for the patient to identify where the mold exposure is occurring and to remove themselves from it. I always recommend consulting with an indoor environmental professional for testing and remediation advice, but we have also developed effective, natural environmental products at Micro Balance Health Products that can help. There is also an Environmental Treatment Protocol on this website that many people find helpful. Additionally, we have a downloadable Protocol Guide with product recommendations that many people find helpful.
Regular nasal rinsing and irrigation are also key to directly eliminate the mold from the nasal passages before it can reach the sinuses. I also created a homeopathic, oral spray called Sinus Defense that contains transfer factors that act like antibodies to remove the common molds, bacteria, viruses from the body. It has been found to lower the IgG antibodies to molds which cause the delayed reaction that damages the sinus mucosa causing the pits. I have patients who have been using it for years and find that they can tolerate and recover from quite significant mold exposures now when they would’ve been completely taken out and sick for weeks from smaller exposures in the past.
1. Kaliner MA, Osguthorpe JD, Fireman P, et al. Sinusitis: bench to bedside. Current findings, future directions. J Allergy Clin Immunol 1997; 99:S829–48.
Hello – I am so grateful to have found your website. I was a healthy 71 year old until my symptoms began last May. It was around this time that my landlady installed a “new?” HVAC system in her condo that I have lived in for 7 years. My sinuses have been creating copious amounts of mucus that drains down the back of my throat daily and nightly ever since – Prescription and OTC medications have not helped. Several months ago I discovered black mold on the outside of my bedroom vent and property management came with mold spray and scrubbed it off – also on the duct as much as I was able to see. They were unwilling to do a complete inspection/clean out of the equipment. An ENT suggested a CT scan but I haven’t had this done yet.
Long story here, but I am finally able to afford moving. My question is, how concerned should I be with moving my belongings to a new apartment – such as my mattress and box spring? How extensively will I need to clean everything before moving, to eliminate mold spores? I am so tired of wondering about everything and always searching and reading online for answers. Living in fear and so much concern about my health and brain fog has contributed to my anxiety around this. Really needing some professional guidance and support. Happy to pay for personal consultation.
If you can afford to do some testing of your current home to see exactly what levels and types of mold you are dealing with there. Without testing, it would be difficult to provide a remediation-type assessment for your belongings. The ACAC.org website is a good resource for locating a mold inspector in your area to help with this. If you can afford to, the best and clearest route to health are to take as little with you as possible from the current environment. Things like pillows and mattresses should be replaced. Clothing can be washed with the EC3 Laundry Additive, and non-porous items can we wiped down with EC3 or cleaning peroxide. Anything that can absorb mold spores should likely be replaced. If you have the testing, though, this could also be used to recoup damages from your landlord for having to replace these things from the mold exposure incurred inside the home. Mold from anything caused by negligence of the property or improper upkeep on the owner’s part is their responsibility to make right.
We are currently using the EC3 products to bring down the mold count in our home. They are helping. Our mold problem appears to be from structural construction defects which led to hidden water leaks discovered only after the water damage become visible. All family members are displaying some symptom of mold exposure.
1. Two of us are particularly sensitive to HIGH HUMIDITY conditions especially when the temperature does not warrant use of the a/c or heater. A recent change in weather brought high humidity and rain: one of us developed severe sinus pressure and headache; another developed redness/swelling/itching on the face and around the eyes. Should we be monitoring indoor humidty levels? What measures can we take to lower humidity especially when the a/c and heater are not is use?
2. One family member has chronic redness over the area of the frontal sinuses. They have started CitriDrop Spray and Sinus Defense. Since we have been using the EC3 house products, they feel better most days but high humidity days trigger pain in the area of redness and in the other sinus areas. Per this article, they will be adding in CitriDrops Diet Supplement and nasal rinses. Do you advise any other measures? Is the chronic redness a sign that a high level of fungus is in the frontal sinuses?
Thank you very much for any guidance you can provide.
The most important piece of this puzzle is to fix where the water is coming in so that the work you are doing will make a lasting difference in the health of your home.
1. You should always monitor indoor humidity levels. Indoor humidity should not rise above 50% for optimal indoor air quality and to prevent mold growth. Dehumidifiers, whole home or in rooms can be solutions.
2. I cannot speak to particular conditions without seeing the person as a patient. I would advise seeing an ENT if the pain and redness continues. It could be a histamine reaction to the mold or would be swelling and redness due to an immune reaction or infection. A doctor would need to advise on this after seeing the patient. Controlling the humidity and solving the exposure issue should always be the first step, though.
May I ask a question? I suffer from frequent headaches. I have been treated by Cleveland Clinic since 2019 for multiple molds. My nasal swab showed 2 infections alpha strep and Keibseilla but no molds. I have to agree that antibiotics do not work as I have been on mipirocin/gentamicin twice. the 2nd time they added Lugols solution 2 gtts with the saline nasal rinses done BID. I have had sinus symptoms for years. (I grew up near the ocean in Maine, but even in our home in Upstate NY, we tested positive for many molds. I know I have a mold allergy , because when the pulmonologist did a RAST and said i was negative for allergies and I stopped my allergy medication,.I developed pneumonitis and was very sick for months. Five years earlier I had survived a heavy load of blood clots in both lungs causing pulmonary HTN, (which did resolve ! but I am still on Eliquis. Will Citrus drops help me since my mold is in my lungs? Will Sinus Defense be able to remove the mold from my body? My mental thinking is impaired and I am hoping to improve my mental clarity.
Here is Dr. Dennis’s reply to your question:
1. Search for the environmental mold. Your symptoms seem mold-related.
Meanwhile, use a HEPA AIR filter, cold fog with EC3 3x wk, use EC3 candles where you are, and use the EC3 laundry additive. These things will help to bring mold counts down temporarily.
2. Get a sinus CT and see an ENT doc to find if the fungus is in your sinuses.
3. You can try Ctridrops Dietary Supplement both in water orally & in a Nasal wash & Sinus Defense 9 sprays 2-3 x day to see if it helps.
4. Adhere to a Anti-Yeast diet, if diet does not clear brain then it’s likely you are in mold in your environment.
5. Best way to remove mold from body is remove mold from your air.