In 1989 I had several patients who did not respond to traditional sinusitis treatment; none of the customary therapies worked–antihistamines, decongestants, nasal washes, antibiotics, steroids, both nasally and orally, allergy shots and multiple surgeries. One particular patient case stood out because of its severity. Endoscopically this patient’s sinuses were always full of pus and polyps, regardless of the maximum medical therapy that I could provide, including surgery and nasal antibiotics. Then, one day he came in and his endoscopic exam showed that he was completely clear for the first time in years. So, of course, I asked him what he had been doing. Surprisingly, he said, “I was at the beach for 2 weeks.”
AHA! It was as if a light had been turned on! His sinusitis trigger had to be environmental. Something in his home environment must be making him sick, because the beach getaway had finally given him a reprieve and allowed his sinuses to heal.
Of course, questions from me about his home air quality and surroundings and about his environment while at the beach abounded. With each of his responses, we got closer to the crux of the issue. We then postulated that mold was the cause and began doing mold testing on his clothing and in his nose. We found high levels of mold growing on the SDA agar test plates (special agar on which mold grows quickly) that backed up the hypothesis. It wasn’t enough, though. It was just one case, so I need to dig deeper.
Looking for Environmental Triggers for Illness
Soon after, we started asking all of our sinusitis patients to do their own environmental testing and sending the test plates to Immunolytics Lab for analysis on the number of mold colonies present and for the identification of the mold types. We also began doing CT scans and Endoscopic sinus exams to determine what environmental air mold-count level would take the sinus lining (mucosa) from severe inflammation, swelling, polyps and infection, back to normal. In other words, we wanted to know what level of mold these patients could live in and still be able to respond to treatment. All were currently on maximum medical therapy and were not improving to normal appearing mucosa.
Over the course of our study, we tested 639 patients who had not been improving on normal medical therapy. We found that most of them (if they had moderate sinusitis) would normalize their sinus mucosa after they got the mold counts in their homes down to 0-4 colonies on a 1-hour mold plate exposure. But those who had severe sinusitis had to get their counts down to 0-2 colonies on a 1-hour mold plate air exposure to normalize.
It is important to note that these mold-sensitive patients also had a genetic defect in the T-cell receptor site that predisposed them to react to mold up to 9,000 times what is considered a normal inflammatory reaction. For these patients, reducing the mold load in the air became the single most important part of their treatment, and targeting a way to lower the severe immune hyperreactivity to mold caused by the defect in the T-cell receptor site was the second.
When you think about it, it all makes sense, because the volume of air breathed in through the nose far exceeds the volume of antimicrobial spays and irrigation that can be employed to counteract the fungal load in that air. Reducing the fungal load in the air has been shown to be five times more effective for eliminating chronic sinusitis than all other treatments.
A New Way of Treating Sinusitis
Knowing all of this information significantly changed my practice and started to alter the way I was evaluating and treating patients. For example, it became very important to measure air fungal load and particle count and to find a simple solution to treat the air to reduce fugal load until the patent could either get into a safe environment or properly remediate the space. The idea was to continue adding more air treatment until the symptoms improved back to normal, if possible. Of course, there were places that were so contaminated that this approach was not adequate and the patient had to move into a safe place to improve.
The next step was figuring out a way to address the immune response to mold. Sinus Defense was developed with transfer factor that would bind to the molds in the body and remove them through cellular immunity. The way this works is that when the Sinus Defense transfer factor recognizes and attaches to the mold, the white blood cell (macrophage) would then attach to it, and effectively destroy it. The beauty of how Sinus Defense works is that it lowers the immune reaction to mold by lowering the fungal load in the body simultaneously. I found that the use of Sinus Defense and lowering mold counts in the environment with antifungal nasal treatment made a big difference in my patients’ recovery. It was all about fungal load management both in the air, in the body, and in the sinuses. If the air fungal load was too high, the medical treatment would not be effective, though.
Mold, Mycotoxins, MVOCs and Chronic Illness
As time went on, it was obvious that many of these patients had multiple systemic symptoms like severe fatigue, muscle and joint pain, endocrine disruption with loss of thyroid, cortisol, sex hormones, and growth hormone, fibromyalgia, gut issues, hearing loss, vision decrease, dizziness, muscle weakness, paralysis, tremors, and cognitive decline. Why? I kept asking why? There must be something else the mold was doing besides just the allergic, immune component. That is when the ability to test mycotoxin levels in humans became available.
At the time, Dr. Bill Rea of the Environmental Health Center in Dallas was one of the only physicians doing this work, but he was testing these patients for environmental toxins. Dr. Rea had determined that most of them tested positive for mycotoxins (mold toxins). This was a major breakthrough in directing human health mycotoxicosis treatment. All the mycotoxin chemical structures and mode of action had been discovered, but it was not in the mainstream human medical literature. It was mostly in the farm animal, veterinary literature, where a number of cows died from eating Aspergillus contaminated corn that was stored in a silo. Mycotoxins are chemicals that are low molecular weight, small molecules that are produced by the fungus. There are 300-400 compounds recognized as mycotoxins but only 10-12 receive attention as human threats.
Below is a table showing which fungi secrete which mycotoxins. The mycoxins are very small oily particles that float on dust particles that are inhaled through the nose into the sinuses and lungs. So, the highest concentration of mycotoxins in the body is in the nasal sinus mucosa. This concentrated mycotoxin location may account for the loss of smell being one of the first symptoms of mold exposure. Since the thousands of microscopic olfactory nerves of smell penetrate the roof of the nose to exit the brain and line the vast area of mycotoxin concentrated nasal mucosa, mycotoxins can easily enter the brain by the same route where they can cause cognitive decline and pituitary damage which can dysregulate all of the hormones in the body. The pituitary dysregulation in mold exposure prompted the development of CellTropin a homeopathic that supports the pituitary gland by the use of pituitary extract, arginine is an amino acid that increases circulation and the release of growth hormone which aids in the production of new cells, and astragalus which stabilizes the telomeres that hold the ends of DNA together to stabilize cell degeneration.
We were also faced with having to develop a safe, natural effective way to remove the mycotoxins from the air and clothing. This led to the development of the EC3 family of products. Mycotoxins are captured on the pre-filter of a HEPA filter and they are destroyed by EC3 spray and fogging solution, EC3 Candles, and EC3 laundry additive. This is done naturally by using the oils from several botanical seed extracts. We were focused on ONLY using ingredients that were NOT toxic to humans. Most of these mold-sick patients had a propensity to be chemically sensitive—it was a vicious cycle in which chemicals make them more mold sensitive, and mold makes them more chemically sensitive. It is the same immune reaction to both. The idea was to be able to lower the air load of mold and mycotoxins enough to begin healing the patients until they could either professionally remove the cause and contamination in the moldy environment properly or get into a safe place in which they began to feel better.
Mold also produces Microbial Volatile Organic Compounds (MVOCs). These are low molecular weight, high vapor pressure and low water solubility compounds that easily evaporate into the air and are responsible for the moldy, musty smell indicative of water damage. MVOCs can cause a decrease in immune system activity by lowering the white blood cell count, among other things. About 1,000 different MVOC’s are released by about 400 different bacteria and fungi. These are measured by gas chromatography-mass spectrometry. Today this test is not typically done in an environmental assessment, nor is mycotoxin testing usually done by environmental testing companies. This is unfortunate, because when an environment is tested for mold, most companies are not really measuring exactly what is making people sick. Then, an environment with a very low-to-zero mold count is declared as “safe”, but is still causing illness. That’s why, for very sick patients, we always recommend first getting into a safe place where you know you are getting better and not taking anything with you from the moldy place. In a safe environment, even just a temporary one, the body can start to heal, and they can deal with the environment from there. It takes the stress and pressure off a bit when healing is first and their home and things can be handled with less immediate urgency. If after remediation they do not feel well in the environment, then it is best to leave. I tell my patients to think of MVOCs like the smoke damage after the fire: When everything is cleaned up, there is still the smoke odor, because it penetrates sheet rock and will go through a sealed plastic bag. MVOCs are just as powerful and as potent. This is also why many very neurologically sick patients cannot improve in a house after remediation.
Mycotoxins in the Sinuses
More discovery came later. Since many of these patients have chronic sinusitis, many of them require endoscopic sinus surgery to open all of the sinuses to clean out any infection and/or fungus and to irrigate them with Amphotericin-B, a very effective antifungal. Many patients had polyps inside the sinuses. In removing these polyps and mucosa, we placed a specimen on an SDA agar mold plate to determine if mold would grow out. After about 4 days, no mold grew because they were on an antifungal nasal nebulization pre op, but there was a brown halo around the sinus tissue.
Dr. Hooper’s mycotoxin lab tested the brown halo and found mycotoxins. In addition to their sinusitis resolving, the two patients found that their neurological symptoms also improved after surgical removal of some of the sinus mucosa and Amphotericin irrigation. This was of note, because their neurological symptoms had not improved on maximal medical therapy alone. At this point, we had enough objective data to show that neurological symptoms caused by mycotoxins in the sinus mucosa could be improved by endoscopic sinus surgery to open and clean all the sinuses and irrigate them with Amphotericin.
Innovations in Treatment for Fungal Sinusitis
Recently, we had a patient who lived in a moldy house for 10 years and ran a mold remediation company, so his exposure was great, to put it mildly. Prior to seeing me for sinus surgery, he had a 10-year history of hearing loss, tinnitus and visual disturbances, with muscle weakness, gut issues and chronic sinus issues. His sinus CT scan showed small polyps in his ethmoid sinuses. He had already undergone maximum medical therapy including months of detoxifying IV’s by a physician in Florida five days per week, but his symptoms of hearing loss, tinnitus, and visual disturbance were not improved. During endoscopic sinus surgery all of his sinuses were opened. We used a new technology to irrigate all eight sinuses thoroughly with a Stryker Cyclone–an irrigation device that uses a vortex-like action to wash every millimeter of sinus mucosa inside all sinuses. We discovered that the thoroughness of mucosal cleaning inside each sinus could drop the mycotoxin level enough to get some neurological function back in the recovery room almost immediately post operatively. Thirty minutes after waking up in the recovery room, this patient experienced hearing recovery, tinnitus resolution, and visual improvement. This special technique is employed on all mold patients now. (Note: When we sent this patient’s sinus mucosa to Dr. Hooper for testing, he found high levels of the mycotoxin Aflatoxin present.)
Lessons Learned
The key lessons learned over all these years are
1.) clean your nose with irrigation and antifungals, and
2) clean your home and clothes.
Clean air means air free of mold, mycotoxins, and MVOCs. Air is the single most important item in achieving long-term wellness from mold illness. The body can do the rest if given the right antifungal, detoxification tools, endocrine support, and anti-Candida diet.
As an Atlanta, GA., Board Certified Ear, Nose, and Throat (ENT) Surgeon I trained at the Johns Hopkins Hospital, the #1 in the world in Ear Nose and Throat training, have over 36 years experience in treating over 30,000 patients with sinusitis, and developed a protocol that is safe, and effective. I am constantly learning new things and improving my own knowledge. I want to reach out to others who are suffering from chronic sinusitis as well as other disabilities caused by exposure to mold and mycotoxins and share with you much of the same information I give my patients.
It depends on how bad and how progressed it is. Some people are able to get a permanent resolution of symptoms with those products and removing themselves from the mold exposure. Others need Rx antifungals or irrigation to get them where they need to be. Then, those products can maintain.
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I finally had the brain power to read this article (having a good day today). Great article. I am going to start the immune defense now.
Thank you for the kind comment.
Can Fungal Sinusitis can be treated permanently with citri nasal drops and citri deitry supplement without any surgeries?
It depends on how bad and how progressed it is. Some people are able to get a permanent resolution of symptoms with those products and removing themselves from the mold exposure. Others need Rx antifungals or irrigation to get them where they need to be. Then, those products can maintain.