Chronic Sinus Problems Caused by Mold?Source: Habitat Quarterly Winter 2010
By Wellington S. Tichenor, MD
Exposure to mold can have many different manifestations. It can vary from allergic manifestations including hay fever and asthma to the toxic manifestations which can include a variety of different conditions. It can also cause sinusitis, or inflammation of the sinuses, which are air pockets in the head.
Sinusitis is inflammation inside the sinuses and initially occurs as a result of obstruction of the openings of the sinuses, which are actually channels as thin as the lead in a pencil. If these channels are blocked, mucus may back up into the sinuses. This mucus is a wonderful culture medium and it can easily get infected. In some cases where it is chronic, this can be due to fungus (fungus, mold and yeast are very similar and we will not attempt to differentiate between them in this article).
Chronic sinusitis (also sometimes called chronic rhinosinusitis, CRS) affects approximately 15% of the population with another 15% of the population having an episode of acute sinusitis in any one year. Unlike acute sinusitis, which often has bacteria as a cause, some current theories of chronic sinusitis find that is related to mold exposure in many cases.
The belief is that there are some patients who have an unusual sensitivity to mold exposure in the environment. This mold exposure can cause inflammation in the sinuses and the inflammation may lead to bacterial infection on top of this mold sensitivity. The mold sensitivity is not actually an infection but rather an immunological overreaction. In the past, we have not been aware of the fungal problem. It is kind of like having an infection as a result of a knife wound, but never realizing that the knife wound was the cause of the problem in the first place.
We are not sure why some people are more sensitive to mold than others and consequently develop these mold-related episodes of sinusitis. One of the theories is that these people have more exposure to mold in their environments, while other theories hold that they are due to the use or abuse of antibiotics.
In a situation in which patients have had mold exposure in the environment for an extending period of time, this extended exposure can cause patients to have this immunological overreaction. This reaction may or may not be due to a true allergy, but in some patients who have more severe problems with fungal sinusitis, we know that they will improve if they are treated the same way patients with more severe allergies are treated: with allergy immunotherapy, which will desensitize them to the molds that they have problems with. We also know that the fungi we may find in the sinuses are the same ones that are found in the environment.
Once the sinusitis has developed, it may become very difficult to adequately treat because of the narrow channels. These drainage areas can become easily blocked from exposure to many things including tobacco smoke, allergy causing substances, foreign bodies in the nose, colds, etc. Once this obstruction occurs, very commonly patients will develop the bacterial infection on top of the initial fungal problem so that there will be two things occurring at the same time.
If the cause of the sinusitis is due to mold, simply removing oneself from the mold or removing the mold from the environment may not be enough to resolve the problem. If the inflammation has already caused an obstruction, it may be analogous to what happens in the case of patients who have cholesterol obstructing the arteries in the heart: once the obstruction gets to be too great, simply removing the cholesterol may not solve the issue if the arteries in the heart have already become blocked.
As a result of all of the above, it becomes critically important for patients who have mold exposure to have the mold source removed as quickly as possible in order to hopefully avoid developing sinus problems.
Once the sinusitis has developed, treatment may include antibiotics, antifungals, mucus thinners, decongestants, irrigation, anti-inflammatory agents, and steroid nasal sprays. Occasionally surgery will be necessary, but usually, if a patient sees a medical (as opposed to a surgical) specialist in sinusitis, it can be helped. In the past, surgery was performed frequently, but the most respected review organization, called the Cochrane Review found that there was no advantage of surgical over medical treatment. Medical treatment can be very difficult however, so discussion with your doctor and appropriate specialists are important. For more information, please go to the website: www.sinuses.com.
Dr. Tichenor is an allergist in private practice in New York, New York. He is a fellow of the American Academy of Allergy, Asthma and Immunology and is an Associate Clinical Professor of Medicine at New York Medical College. He is a member of the 1-800-GOT-MOLD? Board of Advisors.
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