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.
– 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.
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Catherine Fruechtenicht is a freelance writer, blogger, and former magazine editor. She currently dedicates her time and resources to running her blog https://moldfreeliving.com, where she discusses practical tips for health and wellness for the growing population of people dealing with mold- or environmentally-triggered illness. Having dealt with chronic and debilitating symptoms caused by mold in her own home, she shares expert information, tips, and experiential knowledge from her and her family’s journey back to wellness on her blog to help others find hope and healing.
Dr. Dennis is so wonderful! I wish I had an ENT locally with his talents. Does he have a network of other Mold Literate ENT’s? Particularly in the state of Minnesota? I’d be grateful for further counsel as I navigate continued treatment of mold in my sinuses.
Hi Michelle,
Dr. Dennis is the only ENT doing the irrigation sinus surgery with the Cyclone for mycotoxicosis as of now. He is very willing to consult with and/or train any other ENT surgeon on the procedures and techniques he uses, though. If you are an established patient with a local ENT, you can give them Dr. Dennis’s name and practice information to reach out to him. The issue is always the barrier of standard of care taught in medical school for antibiotics, steroids, and surgery, rather than for investigation as to the cause and trigger of the sinusitis. You can also employ much of his sinus protocol at home, if you have not already. Using those interventions and addressing your fungal exposure load could help you to avoid surgery or the need for additional sinus treatment.
I am following your full protocol as of yesterday. Please tell me what to do if my ENT will not do a fungal irrigation on my sinuses? I tried talking him into it but no luck. I am going to call another ENT today. What do I do if I strike out there? Is this something I can do at home with my irrigation machine? I know I need a fungal medication.
Also, my ENT wants me to take a steroid and antibiotic rinse. Is this a waste of time like it has been in the past? I haven’t been to an ENT in 3 years but I did get tested 6 months ago for mold in my sinuses, MARCONS and a bacteria (from bird poop). I’ve been doing Citridrops rinses for two months and I am so much better but have this yellow/green post nasal drip that won’t leave!
The recurrent nature of your sinusitis makes me wonder if you are still being exposed to mold somewhere, either in the home, car, workplace, or contaminated belongings. If this is the case, then the fungal sinusitis will not go away despite surgery and treatments. If your environment is completely clean, and if no fungal ball is present on your sinus CT scan then you may respond to longer term use of antifungal nasal sprays such as amphotericin. Marcons almost always is a secondary infection from the mold and treating it usually does not work at all if fungus is still present. Mycotoxins reduce the immune support of the mucosa and opportunistic bacteria can then colonize.
I work in a moldy school and have debilitating exhaustion and headaches. If it gets under control and then I cry or something, comes back with a vengeance. I can sometimes get some relief from Itraconozole and using BEI nasal spray but am still in the environment. Have to work…Can change schools back to an old school, but had a problem there as well…What can I do.
I am sorry you are dealing with this, it is certainly a tough situation. As hard as it may be, please see if there are any options you have for working without being in that environment. It is hard to impossible to heal or get much better when the load is still coming in. Oxygen therapy at home might help you but again, this is just a stopgap measure and ongoing sensitization can get worse. It may help to have an independent industrial hygienist come and check the school. This might be with your having to pay for it initially and hopefully get reimbursed later, but proving the school is problematic may help not only your health but that of countless other students and teachers. One of my patients went through something like this, the school was ultimately condemned but it took quite some time for that to happen. I wish you well with this.
Could mold be a cause to test positive for autoimmune hearing loss?
Susan Tanner
September 19, 2022 at 2:10 am - Reply
Anything that triggers autoimmunity, and mold certainly is one, can initiate hearing loss. I’d definitely have your sinuses checked for fungus and see if you have elevated mycotoxin levels in your body.
Coastal Ear Nose and Throat
April 29, 2021 at 1:48 pm - Reply
I have gone through the blog post and I must admit it is very informative. I liked the writing style too. Keep up the good work and share more contents. Cheers!
I have mold illness and have started your protocol…I’m allergic to alcohol among millions of other things…the nasal spray has alcohol in it…can I make my own with the citidrops?
From Dr. Dennis:
The CitriDrops Nasal Spray does NOT contain alcohol. The Sinus Defense, which is a sublingual, homeopathic remedy, does contain alcohol, as most homeopathic suspensions do. You can safely use the nasal spray. It is a different product than the CitriDrops Dietary Supplement. The nasal spray also has decongestant properties. Use can instill 3-4 drops of the CitriDrops Dietary Supplement in a 1 ounces nasal spray pump bottle of simple saline, like Little Noses, to use as a nasal spray. It will not be the same, but can help.
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Dr. Dennis is so wonderful! I wish I had an ENT locally with his talents. Does he have a network of other Mold Literate ENT’s? Particularly in the state of Minnesota? I’d be grateful for further counsel as I navigate continued treatment of mold in my sinuses.
Hi Michelle,
Dr. Dennis is the only ENT doing the irrigation sinus surgery with the Cyclone for mycotoxicosis as of now. He is very willing to consult with and/or train any other ENT surgeon on the procedures and techniques he uses, though. If you are an established patient with a local ENT, you can give them Dr. Dennis’s name and practice information to reach out to him. The issue is always the barrier of standard of care taught in medical school for antibiotics, steroids, and surgery, rather than for investigation as to the cause and trigger of the sinusitis. You can also employ much of his sinus protocol at home, if you have not already. Using those interventions and addressing your fungal exposure load could help you to avoid surgery or the need for additional sinus treatment.
I am following your full protocol as of yesterday. Please tell me what to do if my ENT will not do a fungal irrigation on my sinuses? I tried talking him into it but no luck. I am going to call another ENT today. What do I do if I strike out there? Is this something I can do at home with my irrigation machine? I know I need a fungal medication.
Also, my ENT wants me to take a steroid and antibiotic rinse. Is this a waste of time like it has been in the past? I haven’t been to an ENT in 3 years but I did get tested 6 months ago for mold in my sinuses, MARCONS and a bacteria (from bird poop). I’ve been doing Citridrops rinses for two months and I am so much better but have this yellow/green post nasal drip that won’t leave!
THANK YOU SO MUCH FOR HELPING ALL OF US!
The recurrent nature of your sinusitis makes me wonder if you are still being exposed to mold somewhere, either in the home, car, workplace, or contaminated belongings. If this is the case, then the fungal sinusitis will not go away despite surgery and treatments. If your environment is completely clean, and if no fungal ball is present on your sinus CT scan then you may respond to longer term use of antifungal nasal sprays such as amphotericin. Marcons almost always is a secondary infection from the mold and treating it usually does not work at all if fungus is still present. Mycotoxins reduce the immune support of the mucosa and opportunistic bacteria can then colonize.
I work in a moldy school and have debilitating exhaustion and headaches. If it gets under control and then I cry or something, comes back with a vengeance. I can sometimes get some relief from Itraconozole and using BEI nasal spray but am still in the environment. Have to work…Can change schools back to an old school, but had a problem there as well…What can I do.
I am sorry you are dealing with this, it is certainly a tough situation. As hard as it may be, please see if there are any options you have for working without being in that environment. It is hard to impossible to heal or get much better when the load is still coming in. Oxygen therapy at home might help you but again, this is just a stopgap measure and ongoing sensitization can get worse. It may help to have an independent industrial hygienist come and check the school. This might be with your having to pay for it initially and hopefully get reimbursed later, but proving the school is problematic may help not only your health but that of countless other students and teachers. One of my patients went through something like this, the school was ultimately condemned but it took quite some time for that to happen. I wish you well with this.
Could mold be a cause to test positive for autoimmune hearing loss?
Anything that triggers autoimmunity, and mold certainly is one, can initiate hearing loss. I’d definitely have your sinuses checked for fungus and see if you have elevated mycotoxin levels in your body.
I have gone through the blog post and I must admit it is very informative. I liked the writing style too. Keep up the good work and share more contents. Cheers!
“In 1999 the Mayo Clinic wrote their first article showing that mold was the cause of 93% of all chronic sinusitis. ”
Can you provide the article? The highlighted,links do noit.
https://www.sciencedaily.com/releases/1999/09/990910080344.htm
This man saved my life! You need to listen to him!
From Dr. Dennis:
You are too kind. Thank you so much for writing. God Bless you. My patients have been my greatest teachers.
Will this treatment also help black mold in the ears?
Which treatment? The surgical irrigation with the Cyclone?
I have mold illness and have started your protocol…I’m allergic to alcohol among millions of other things…the nasal spray has alcohol in it…can I make my own with the citidrops?
From Dr. Dennis:
The CitriDrops Nasal Spray does NOT contain alcohol. The Sinus Defense, which is a sublingual, homeopathic remedy, does contain alcohol, as most homeopathic suspensions do. You can safely use the nasal spray. It is a different product than the CitriDrops Dietary Supplement. The nasal spray also has decongestant properties. Use can instill 3-4 drops of the CitriDrops Dietary Supplement in a 1 ounces nasal spray pump bottle of simple saline, like Little Noses, to use as a nasal spray. It will not be the same, but can help.