I have always believed that sinus disease was caused by both bacteria and fungus. Now, the latest scientific research proves that mold is a major cause of chronic airway-digestive inflammatory disease (CAID). It not only leads to sinus disease, it can affect each of the limbs that are connected to this disease process. Mold
can trigger lung problems, including asthma. The inflammatory process spawned by a reaction to mold is also responsible for reactions in the upper and lower digestive tracts, affecting gastroesophageal reflux disease (GERD) and other stomach ailments. Mold can cause allergic reactions as well, further contributing to CAID. The connection between mold and sinus problems is so profound that it is forcing researchers to rethink the entire disease process, beginning with creating a new definition for sinus disease and chronic rhinosinusitis.
The term rhinosinusitis means “inflammation of the nose and sinuses.” Traditionally, doctors and researchers believed that this inflammation was caused solely by bacterial infection, which could then be treated by antibiotics. The relationship between poor health and mold was inconclusive and thought to be limited to fungal allergies that were present in less than 10 percent of cases. However, recent studies indicate that fungus is likely the cause of nearly all chronic rhinosinusitis.
In 1999, a team from the Mayo Clinic headed by Jens Ponikau, David Sherris, and Eugene Kern shed tremendous light on this subject. Using new techniques for culturing mucus samples, they proved that 96
percent of the patients they tested were found to be culture positive for fungi that were causing CAID symptoms. The most common offenders were Candida albicans, Alternaria, Penicillium, Cladosporium, and Aspergillus. On average, most patients had more than two types of fungus present in their mucus, and some patients had up to eight. What’s more, even normal, healthy individuals - those patients who did not have symptoms of chronic rhinosinusitis also cultured positive for the same fungi as patients with chronic rhinosinusitis. In fact, they found that almost everyone seemed to culture positive for fungi! So why then would fungus affect some and not others?
Ponikau, Sherris, and Kern determined that the difference seemed to be in the immunological response that each individual had toward mold. They proved that there is an immune-mediated response, different from an allergy, which occurs in people who react to the mold present in their body. This immune response starts off with a white blood cell called a lymphocyte, which secretes a substance called cytokines. When a fungus is in the vicinity of a lymphocyte, in mold-sensitive patients, it will produce and secrete two types of cytokines, which enlist other white blood cells (called eosinophils) to prepare themselves to attack the fungus, which is seen as a foreign invader to the body. Once eosinophils are called on by the lymphocyte, the eosinophils accumulate tiny granules of toxic material called major basic protein. Another cytokine activates the eosinophils to secrete the major basic protein and fight off the mold.
This all seems like a great mechanism for the body to rid itself of fungi. However, once the major basic protein is secreted, it has toxic effects on the delicate mucous membrane of your sinuses and nose, causing swelling and erosion - an inflammatory response. Once this occurs, the cilia that normally push the mucus out of the nose and sinuses cease to function. The mucus pools and then bacteria can multiply and cause the infection to fester. Furthermore, the major basic protein causes erosion of the membranes, allowing bacteria to freely invade the mucous membrane, causing further inflammation and infection. The bone underlying the sinus lining can become infected, called osteitis. The membranes of the sinuses swell and can start to form polyps.
Based on this study, scientists now believe that chronic rhinosinusitis is not only a direct result of the bacteria entering the nasal and sinus membranes but an indirect result of the immune response to fungi. More to the point, they believe that this is an abnormal response: They found that healthy patients lacked this immune response and, therefore, do not have the same reaction to fungi.
With this new knowledge comes many more questions and different views on what these data actually mean. We still do not know why some patients have an abnormal response to fungi. Some researchers are now studying whether the fungus reaction is really abnormal or whether it is a defense against a worse disease like cancer. For example, recent research has shown that children with asthma have a lower incidence of developing brain tumors. Maybe on some level, the mold in our systems protects us from other health issues. The answers still await us.
This research has given us the tools to determine if your sinus and nasal problem is due to an immune response to fungi. A new test has been developed that identifies the presence of major basic proteins in the mucus and/or a high concentration of eosinophils. This technology is now becoming available, but requires a visit to an ear, nose, and throat (ENT) physician specializing in nasal and sinus disorders.
Because I believe that CAID is probably caused by both the response to fungus and the bacterial infection that follows, I choose to treat both the bacteria and the fungus. If we can return the balance of the bacterial and fungal flora to normal, control the abnormal response to the fungi that has been identified through this research, and repair the membrane breach that occurs as a result to the toxins, we will be able to improve the control of sinus disease and make you feel better.