Chronic Sinusitis, Environmental Triggers, and Achieving Lasting Relief

by Dr. Donald Dennis, MD

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.

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