Given the Undeniable Link Between Chronic Sinusitis an Fungi,

Why is it Still So Hard to Find an ENT that will Treat for Mold & Mycotoxins?

By Cesar Collado,

Dr. Dennis is always looking to take mold off of the table for his chronic sinusitis patients, because experience has taught him that this strategy yields the best results for most patients, and also does no harm for those with other or additional issues to fungus/mold. Since we now believe that up to 96% of chronic sinusitis may be caused by fungus or mold, this technique is a sound and proactive approach. (Note: The origin of this percentage will come later in the text.) To that effect, one unique strategy employed by Dr. Dennis during sinus surgery is to take tissue specimens from the infected sinus for the lab to later culture for mycotoxins.

By the time a Dr. Dennis performs surgery on sinuses, lots of evidence that furthers Dr. Dennis’s strategy for the need to identify and address mycotoxins has already been done in the months and weeks leading up to the surgery. For example, to determine the need for surgery in the first place, advanced imaging (CT scans) must reveal specific abnormalities and evidence of mucous thickening. These scans can also reveal fungus growing in the sinus.

In addition, patient symptoms, urine mycotoxin testing, or other circumstantial evidence revealed during a detailed review of the patient’s diagnostics, medical, and home history has also been gathered. Any indication or evidence of water damage in their indoor living spaces is of particular note during this phase.  Then, physical symptoms such as tremors, ataxia, vertigo, and headaches are common indicators of mycotoxin poisoning in the sinuses and usually subside after acute treatment with antifungal medications during sinus surgery. Keep in mind, this is still before mycotoxin testing results are revealed by the lab.

Why aren’t more ENT surgeons taking this effectual approach?

Addressing mold and fungi and their role in Chronic Sinusitis remains controversial. To that end, most, if not all ENTs, will “clean out” sinuses, remove nasal polyps, and prescribe medicine for bacterial infections.  In the event a “fungal ball” is identified, they will remove it; however, the use of antifungal medicines during and after surgery is rare. Thus, the return of a fungal infection inevitable.

It wasn’t until September 1999, where the Mayo Clinic published a study of 210 patients with chronic sinusitis, 96% tested positive for fungi in their mucous, that the causal relationship between fungus and sinusitis were formally acknowledged. 40 different kinds of fungi were discovered, an average of 2.7 types of fungi per patient.  In a subset of 101 patients who had surgery to remove nasal polyps, the researchers found eosinophils (a type of white blood cell activated by the body’s immune system) in the nasal tissue and mucus of 96% of the patients. But, even after this study was widely published and acknowledged by the medical community, why hasn’t the treatment approach to Chronic Sinusitis changed? Why is Dr. Dennis’s strategy still so unique?

Dr. Dennis’ practice for years has had a skewed population as patients come to him to address fungal sinusitis and mold illness. Because of his experience over the past four decades caring for patients with fungal infections, he has some tools that other physicians do not have and acquired wisdom to identify patient conditions.

Most important is his practical recognition of the sensitivity  of the olfactory nerves  and the fact that the sinuses are microns from the brain.

Amphotericin B is a well-known, potent antifungal medication. When given intravenously, it is well known for its severe and potentially lethal side effects.  It is poorly absorbed and not a candidate for oral treatment; however, the Mayo Clinic and other physicians have popularized the use of amphotericin B in nasal lavages during surgery for chronic fungal sinusitis and the use in nasal drops as maintenance therapy. Because of the significantly lower dose and “topical use” in the sinuses with patients with fungal sinusitis, it is very effective and lacks in serious side effects as it is not absorbed and metabolized by the body. This methodology was described in this article coauthored by Dr. Dennis and the late Jack Thrasher, Must See Article on Mycotoxin Poisoning.

So why is this important for you?  If you have severe neurological symptoms, you may continue to suffer for many years until mycotoxins are identified and treated by your physicians.  The average length of suffering from a more recent article I read on mycotoxin poisoning in sinusitis was SEVEN years (Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit? Toxins, June 2014 By Brewer, Thrasher, Hooper)

Finding doctors to treat mold-related illnesses is hard enough.  Finding an ENT that embraces these practices is much harder.  Why is that?  Well, I was able to find numerous studies to determine if amphotericin B is effective in treating Chronic Sinusitis.  Unfortunately, many of these studies were focused on  general populations with chronic sinusitis without a pre-determination that it was fungus that caused the sinus infection.  These studies are not likely to yield successful outcomes because they include patients that are predetermined to fail. I do not understand why certain medical innovations are so slow to adopt and meet resistance. I do not think there are any arguments that fully justify the resistance to change occurs often in medicine.  Why is it that   adoption of new ideas can take decades?

Medicine is one of the modern sciences that is very slow to change. The Ear Nose and Throat community has been aware of fungal sinusitis; however, the specialty has resisted the recognition of the prevalence of the fungal role in chronic sinusitis for many years. Encouragingly, during very recent times, more and more articles on fungal sinusitis have been accepted and published in peer review journals.  Still, finding a physician that treats fungal sinusitis AND that will utilize amphotericin B if needed in procedures and maintenance therapy is going to be a challenge for sufferers.  Until the medical community shifts its approach, the burden to find the right doctor still lies on the patient.  Diligently knowing your symptoms coupled with careful review of practice websites, physician bios, and even calling the office are all good practices.  Otherwise, you may find yourself with numerous doctor’s visits and surgeries.

Take Ulcers for Example

During my career, I had the opportunity to witness the evolution of ulcer treatment.  The specialty was Gastrointerology.  Treated by surgery in the late 70s and 80s, several successful medications populated the top of the annual Top Selling Pharmaceutical for decades.  Tagamet, Zantac, Prilosec, Nexium were all blockbuster drugs and led the pharma industry in sales up until the early 2000s.  But in 1982, Two Australian Physicians identified the link of bacteria, h-pylori to ulcers and published their findings.  Very slow acceptance by the GI community occurred and NIH recognized the link in 1994. Even after he CDC launched an awareness campaign for h-pylori in 1997, adoption remained astonishingly slow. The use of proton pump inhibitors remained a dominant practice. In 2005, Drs. Barry J. Marshall and J. Robin Warren won the Nobel Prize for Physiology (Medicine) for this discovery. Today, antibiotic therapy to treat ulcers is the “new normal” .  Past “treatments” are now “symptomatic relief” for sale without prescriptions (OTC). That is 28 years of my observation for complete recognition of new science.

Discussion

I see a real challenge for patients suffering from mold and mycotoxin poisoning.  It is tragic to see patients who are completely debilitated and have lost physical control of extremities and experience brain fog, dizziness, and memory issues.  If the patient has lived in a water-damaged home or building and if (and only if) mycotoxin poisoning in the sinuses is the cause, there is only one way to help the patient get well: remove the mycotoxins from the sinuses.  The human body’s ability to fully metabolize these potent neurotoxins is limited.

In most cases, when Dr. Dennis’s specimens from the surgeries are sent off to the lab to identify if mycotoxins exist in the patients’ sinuses, the toxin is, indeed, present and when removed, the patients’ symptoms subside.  I have heard and read countless testimonials where lives have been changed for the better by this practice.  In some cases, decades of illness and “big bags” of failed medications tried are revealed by patients.

I have a genuine concern that the ENT community’s ability to adapt to change can have an enormous impact on millions of patients with severe neurological symptoms and illness.  Just this year, numerous cities like Houston were leveled by hurricanes, which will undeniably yield mold and mycotoxin poisoning that will be epidemic for years.

Hurricane Harvey Impacts

It is almost assured that people have returned to water damaged homes.  Complete mold remediation of a completely flooded home is nearly impossible. Much of the literature on mycotoxin poisoning I have read  centers around patients who have lived in “Water Damaged Homes”.  Let’s hope patients and ENT physicians do their research and do what they can to see the alternatives.  If you are reading this article, you know that we all do not have 28 years to wait. In August, the “CDC had its first Fungal Awareness Week” suggesting to patients that if chronic symptoms do not get better,” talk to your doctor about the possibility of a fungal infection”

I can only make a general recommendation to patients to do their research, ask questions, and make suggestions.  I’m sure there are a handful of ENT’s who treat mycotoxins in the sinuses in every geography.  I do not know who they all are!  If you find them, please share these important doctor’s names with the community.

For questions, comments or to share your story, I can be reached at cesarcollado@icloud.com.

Cesar Collado is a former pharmaceutical R&D executive, venture capitalist, and seasoned strategy consultant in biotechnology and technology industries in general. He currently works as an advisor to multiple technology start-ups and advises several companies that provide healthcare and other services for environmental illness.