Finding an ENT Specialist Who Treats the Fungal Cause of Chronic Sinusitis
Many patients come to me after having been to several doctors and they wonder why many of these very good doctors do not recognize mold as a major cause of illness and sinusitis. It is my belief that the answer may lie in the training and medical specialty periodicals commonly adhered to by most healthcare professionals–whether they offer the patient relief or not.
Routine Medical and ENT Training
I was fortunate enough to go to the best Ear, Nose, and Throat (ENT) training institution possible, Johns Hopkins Hospital. While there, I had excellent instruction in all aspects of the surgical and medical management of diseases of the ears, nose, and throat. However, both in medical school and in my specialty surgical training, there was not much mention of environmental illness or illness caused by environmental toxins inhaled or otherwise. So naturally, the environmental trigger or root cause piece of the puzzle was not a part of the patient’s picture. In fact, there were no questions routinely asked on intake regarding a patient’s environment. The patient intake forms asked only questions about medical history, family history, surgical history, and current/previous symptoms; the assumption in medicine being that managing/reducing symptoms with medicines or surgery is the “cure”.
When I began in my ENT specialty, the routine was much the same: to treat chronic sinusitis, the course was and still is always antibiotics, steroids, antihistamines, decongestants, allergy shots, and surgery. And, to be perfectly honest, that line of treatment, for the most part, was very effective–or, so I thought. What I did not realize until I started treating and seeing patients in routine clinical practice was that those typical interventions were not providing long-term relief. You see, during surgical training you are exposed to each subspecialty type case for a finite period (several months usually), so you never see what happens to the patient long term. Then, you get some practice years in and notice that there are a group of patients with chronic sinusitis and/or systemic symptoms that, when given every possible treatment, do not improve long-term if at all. So, I asked the question, “Why?”
“Why?” Is a Powerful Question in Medicine
The fact is that all this typical treatment for chronic sinusitis was very ineffective long term; the disease continued to recur and persist. I saw a patient who had been very sick for 10 years; “everything” had been done for him, but nothing ever helped. One day he came in and his sinuses were totally clear. When I asked about changes to his routine, he said he had been at the beach for 2 weeks. According to him, his physical location was the ONLY change, but his chronic sinusitis was obviously alleviated. That moment, I knew his sinus symptoms were environmental, and I suspected mold to be the environmental trigger that was present in his home but not at the beach. To test my theory, we tested his sinuses and clothing for mold. Bingo! High water-damage indicator molds were present in his sinuses and the same ones on his clothes. Then, we developed a plan to address the mold in his home and in his sinuses and his results were consistently excellent and long term. This was in about 1990.
In 1999 the Mayo Clinic wrote their first article showing that mold was the cause of 93% of all chronic sinusitis. But they did not address environmental mold in the study. Instead, they treated fungal sinusitis by using Amphotericin (an Rx antifungal) nasal mist with some success. After that pivotal article, 23 more articles came out that showed the immune reaction to mold was the trigger causing the sinusitis. Interestingly, though, treating mold as the cause is still “controversial” in most specialties, and the use of traditional antibiotics, steroids, antihistamines, decongestants, then surgical treatment remain the established course of treatment.
Why ENT Doctors Don’t Usually Treat Mold
I think the major reason for the controversy is that many people have mold in their noses and sinus mucosa but do not have sinusitis. Thus, the doctors conclude it cannot be the mold. Also, some people with Chronic Rhinosinusitis (CRS) did not have positive mold cultures from their noses. I think this results from poor fungal culturing in a number of labs. SDA agar is more likely to grow mold, which is not typically used, and DNA fungal testing is more accurate than plate cultures. Additionally, a nasal lavage specimen is best for an accurate test.
After I knew mold was the major cause of CRS, a number of articles came out showing the mechanism of the immune reaction to mold and the genetic defect in one or more of 8 genes that makes certain people react to mold with a multisystem inflammatory response. The reason being that in certain people, a T cell receptor defect is present in which mold causes an inflammatory reaction 9,000 times the normal response when the white blood cells meet the fungus. Described in detail, the eosinophil (white blood cell) meets the fungus, ruptures, releases a major basic protein which destroys the mold but puts a pit in the mucosal lining. When pitting occurs, the mucous cannot get out of the pit and bacteria grow. Bacterial growth creates chronic sinusitis and antibiotics work but only short term because the mold causing the pits has not been addressed. (As I stated before, addressing the mold has to be done by removing it both from the nose and the air.) Thus many CRS patients have MARCONS, which is antibiotic-resistant Staph, and the established treatment, the BEG nasal spray, (active ingredients are a combination of two antibiotics, Bactroban, Gentamicin, and the calcium chelator EDTA) and all the antibiotic sprays are not effective long term because the cause of the pit, the mold, has not been removed from both the patient and the air.
What Can Chronic Sinusitis Sufferers Do for Relief?
When you suspect mold you must remove it from your nose, clothes, and your air.
– Simple ways to clean the environment that are a helpful, Banda-Aid approach to get some relief is a HEPA air filter in each room, EC3 candles, EC3 fogging 2-3 times per week, and using EC3 Laundry Additive in your wash for all clothing and bedding. (I developed all of those products for my patients, but now they are sold at Micro Balance Health Products and on Amazon in the Micro Balance Store.) I advise my patients to get rid of front loader washers as they have problems with mold and make it difficult to wash it from their clothing effectively. The commercial Speed Queen washing machines are best for mold.
– Wash out your nose with a Nasopure bottle and add 4-8 drops of CitriDrops Dietary Supplement per 8 oz water. Irrigate 2 times per day. And use CitriDrops Nasal Spray. The spray is homeopathic, safe for long-term use, and actually addresses environmental allergens and mold.
– Use mold plates to culture every room, car, office, and clothes. If plate counts are significant anywhere, get a professional environmental person who has experience treating sick mold patients and get references. These professionals can help you diagnose your environment and can help devise a plan for proper remediation.
How to Talk to Your Doctor About Mold
In my opinion, the best way to talk to your doctor about the possibility of mold being the cause of your symptoms is to get a mold urine mycotoxin test from either RealTime Labs or Great Plains Lab. Both labs offer direct access testing (DAT) in most states. If your state is not a DAT state, you can contact the lab for doctors close to you who will be able to order the testing for you. If your urine test is positive, it proves both that you are in a toxic environment and that it is making you sick. The doctor is not going to get involved with your environment. Doctors treat people, not environments. Thus, you are going to have to take responsibility for addressing that piece of the puzzle.
If CRS is your main issue and the doctor determines you need sinus surgery, ask him if during the surgery, after opening all of your sinuses, he or she will irrigate with Amphotericin-B using a Cyclone by Stryker. There is a new paper describing the mechanism of use for the Cyclone for this exact irrigation process that will be published soon in the Annals of Otolaryngology and Rhinology. You can search Pub Med for a link to it if needed.
What if All Interventions Are not Helping or Symptoms are Severe?
If your symptoms are severe and neurological you should move and not take anything with you. I realize that is a difficult statement to process, but for some patients, it is the only direct path to true recovery.
Mold secretes 2 kinds of toxins–there are over 400 different toxins secreted by molds– 1.) mycotoxins which are oily particles that float on dust particles, and 2.) MVOC’s (microbial volatile organic compounds), which can go through a sealed plastic bag that can hold water and can go through sheetrock and enter the brain in real-time through the nose. Both mold toxins are neurotoxic, immunotoxic, and carcinogenic. So if you are very ill, the best solution to get well is to remove yourself from the moldy environment and the contents. Nothing works better than the total elimination of the exposure for very sick people with neurologic and cognitive symptoms.
Most really sick people do much better at the beach or desert provided they do not get a moldy place to live. The definition of a safe place is one in which you know you feel better. Establish this first BEFORE any Testing. It takes different people different lengths of time to know for sure if they feel good in a place. I tell my patients that if there is any ambiguity or possible adverse symptoms, then it is NO. Some have to stay 3 or more days to know if it is safe for them. Those that also have asthma have found that when they tell a landlord or property management company that they have asthma and must stay a few days to determine if they have breathing difficulty there, they get much better cooperation than when they try to talk about mold illness or bring up mold. This is the sad truth, but helpful advice for other mold sufferers in a similar situation.