An Interview With Dr. Dennis About Naso-Sinus Mold
When something is fundamentally wrong with your environment—chemicals, allergens, mold, pollutants, and/or other toxins—your body usually knows before you do. It will begin “telling” you of the environmental threat with health symptoms, illness, and eventually disease. If you do not get out, or remove the inflammatory culprit in a timely manner, you may face longer-term treatment just to get your body back to homeostasis. This is particularly true with sickness caused by mold exposure, because mold has the ability to colonize the bodies of susceptible individuals (usually in the sinus or digestive system) and to continue to produce mycotoxins within that host. I am intimately acquainted with the health fallout from this chain of events and shared a lot of the details of my experience with fungal sinus colonization in my previous post.
In that post, I talked about how Dr. Dennis helped me to connect my moldy home environment to my upper respiratory symptoms, chronic sinus infections and multi-system distress, like GI upset, acid reflux, anxiety, depression, rapid weight loss and insomnia. He did this by taking my medical history, questioning me about my environment (this included suggesting that I also do environmental testing to confirm mold and mold toxins in my home) and performing a physical endoscopic examination of my sinuses. I also shared how antifungal nasal treatments, both in his office and at home were fundamental pieces to my healing, because they were directly addressing fungal colonization in my sinus that, if left untreated, could have continued to keep me sick, despite the remediation of my home and maximum mold detox and other treatment therapies.
Today, I want to focus more on Dr. Dennis and his unique approach to treating my sinuses, because it really matters to me to share this information and to help others understand how important it can be to making a full recovery. Dr. Dennis’s approach seeks to eliminate the environmental trigger for the illness in the first place, rather than just the symptoms. When a patient (myself included) finally grasps that their immune response to mold is activating their health issues, all efforts and finances can be channeled to things that will actually help (remediating or leaving the moldy environment, detox, binders, antifungals, diet, etc.), rather than actions and/or pharmaceuticals that will not provide answers or relief.
Throughout my treatment, whenever I asked, Dr. Dennis, was always willing to point me towards medical research and literature on mold/fungus and how it behaves inside the nose and body. I wanted to better understand the science behind all of the nasal and body protocols we were employing to get me well. One of the most important concepts I learned is that the nose is environmental mold’s main gateway into the rest of the body. And, if you are susceptible to mold illness or are immune compromised, mold can colonize and excrete mycotoxins in your sinus. Those mycotoxins can then affect the digestive and pituitary systems, alter your hormones and cognition, and eventually, if left untreated, enter the bloodstream.
I realize that we all inhale mold spores every single day when we breathe. The difference is that some of us (16-20% of the population) are genetically predisposed to an inflammatory response to mold, especially if we spend time in spaces where we are inhaling mycotoxin-producing molds.
Being an ENT doctor, Dr. Dennis obviously understands this principal well and has his mold patients adhere to actions like first and foremost getting out of the moldy environment and then regularly washing their nasal passages with saline with an added antifungal, like CitriDrops Dietary Supplement to directly combat mold inhalation. (Note: CitriDrops Dietary Supplement can also be taken by mouth in purified water to treat systemic symptoms as well.)
The saline washes are intended to flush out mold spores as they enter the nasal passages to prevent colonization in the sinus. He also has some patients use prescription antifungal nasal drops and nebulization to better penetrate the sinuses and eliminate mold that has already taken hold. This is because, according to him, “The very best clinical results occur when the patient physically gets out of the moldy environment, and gets the mold out of the nose.”
Always wanting to dive deeper, I asked Dr. Dennis to allow me to interview him, so that he could contribute more of his insight to the conversation and talk more about treating mold illness from his unique ENT specialist’s perspective. I am so happy that he agreed, because, as you will see, he has a valuable understanding of treatment tools and options that aren’t generally utilized by other, less-specialized, environmental and mold doctors.
Here is my interview with Dr. Donald Dennis, MD:
Me: Hi, Dr. Dennis. Thank you so much for speaking with me today. I mainly want to focus this conversation on mold in the nose, and the sickness that you see in your practice because of someone living in a moldy environment. So, to begin, what portion of the patients that you see have a fungal infection and colonization of the sinus (fungal balls) that require medical intervention?
Dr. Dennis: I am an ENT surgeon, so not all of my patients are mold patients, or dealing with fungal issues. I estimate that approximately 30% of the patients I see have fungal sinusitis. That doesn’t seem like a large number, but for my entire practice, it is significant. Almost all of my mold patients have some degree of sinus fungal infection. When that is the case, we also test their urine for mycotoxins. If mycotoxins are found, the sinuses must be irrigated and cleaned to remove the mycotoxins that are congregated there.
Because mold is inhaled, the highest concentrations of mycotoxins are likely also found in the sinuses, near the brain. So, even without visual evidence of colonization in these patients, meaning those who test positive for mycotoxins in their urine, many have mycotoxins in their sinuses to some extent. It is also possible that a patient’s urine is negative, but he or she still has mycotoxins present in the sinus.
(Note: For reference, single mold spores are microscopic. You can fit approximately 250,000 mold spores on a pinhead. Thus, if someone is living in a moldy home, and constantly inhaling spores, you can see why fungal colonization in the sinus can happen quite easily, especially if that person is immunocompromised or mold sensitive.)
Me: Do all patients who have fungal colonization in the sinus have typical sinus and upper respiratory symptoms, like runny noses and sinus infections?
Dr. Dennis: Not every patient presents with severe sinus symptoms. Some have a genetic predisposition to be mold sensitive. This means that their immune system cannot recognize or process (kill) the antigen. This causes a patient to be immune compromised. Roughly 1 in 4 people in the population have the genetic susceptibility. If you don’t have the genetic susceptibility, your body can identify and remove fungus before it becomes a health problem. In these cases, patients will not present with symptoms unless the mold becomes a fungal infection.
Mold normally does not colonize healthy people who aren’t allergic to it. So, for the immune reaction to occur, mold must enter the nose and the allergic person’s immune system must mobilize eosinophils to come in to get rid of it. That causes inflammation. Eosinophils are white blood cells that migrate into the sinus mucosal lining in response to mold and/or foreign bodies like fiberglass. The eosinophil count will go up in your bloodstream if an antigen is detected. When this happens, the person has extreme sinus symptoms and inflammation.
For example, a normal person would react to mold by secreting 0.01% of their T-cells to get rid of the mold antigen. Mold-allergic people react 3,000 times that—actually 3,000 times 3 interleukins secreted by the white blood cells, which is 9,000 times the inflammatory reaction per mold spore compared to a normal person. You can see why this becomes problematic and can make an allergic person VERY sick, especially if they are living in a moldy home.
Me: I’ve read studies that indicate that nasal secretions from healthy individuals also show evidence of mycotoxin-producing molds in their noses, but, obviously, they aren’t sick. Then, there are studies that show that ALL patients who test positive for mycotoxins in their urine also have mycotoxins present in their nasal mucous. In other words, at some point, everyone has mycotoxins in their nose, but only some people get sick (mold toxicity) from it. Is the issue continuous exposure, methylation disfunction, a genetic susceptibility to mold, or something else, in your opinion?
Dr. Dennis: Methylation and the DNA predisposition for mold illness are two different things. Methylation is the body’s ability to effectively get rid of toxins. It doesn’t have much to do with reactivity to mold itself.
Here is an example: When mold enters the body of a mold-sensitive patient, typically by inhalation, it is attacked by white blood cells (lymphocytes). The lymphocytes secrete three cytokines, chemical messengers produced by white blood cells, called interleukin (interleukin 5, 13 and interferon gamma). The interleukins cause inflammation and interleukin 5 attracts eosinophils (a type of white blood cell). The white blood cells engaged in the immune response often burst and release caustic, major basic proteins. These acid-like proteins burn pits into the sinus lining. The pits become a trap for bacteria which causes infection, pain, and swelling in the sinuses. The pitting keeps the conditions ripe for the immediate return of the infection. Antibiotics do not treat the condition that causes the pitting; they only target bacteria and provide a temporary relief. The pits will not begin to heal until your body stops having to fight against mold.
Another way cytokines are a problem is that they circulate throughout the body causing a systemic immune reaction that can cause significant symptoms, such as muscle and joint pain, fibromyalgia, fatigue, bloating, gas, diarrhea, memory and concentration problems, vessel inflammation, dizziness, headaches, ear infections, and many other problems. Over 90% of people with chronic sinusitis have this genetic predisposition to this significant immune reaction to mold. Only people who are not allergic to mold don’t secrete interleukins when exposed to fungus.
Me: So, what would be the first line of defense for a mold sufferer, in terms of treating the nose, to prevent that reaction?
Dr. Dennis: If you have a mold exposure, and you are allergic to it, the first thing you should do is irrigate your nose with saline with CitriDrops Dietary Supplement added to it—anywhere from 4 drops per 8 ounces of saline to 8 drops per 8 ounces. That will kill both fungus and bacteria. This clears the nasal mucus so that specific antifungal sprays will reach all of the tissue, which makes it much more effective. Your sinuses are like a wall—you have to clean it BEFORE you paint it. Any spray is absorbed better in the mucosa that way and works better.
Me: Can nasal rinsing be enough to stop the inflammation and to resolve the issue?
Dr. Dennis: Nasal rinsing with an added antifungal is very effective and can be enough for some patients when mold hasn’t yet colonized. If you feel sick and like you have a mold build-up, you will have to see an ENT doctor. Some small fungal balls can be removed by nebulizing amphotericin B. Nebulization aerosolizes the medication it into tiny particles, so that it can reach all of the sinuses. There is an added benefit that the amphotericin B causes the hyphae (roots of the mold) to release. Mold hyphae, you see, can grow into very long strands that can penetrate tissue, which I liken to hooks, like when a tick attaches to a dog. So, the aerosolized antifungal in there makes it release. In some patients, if the fungal ball is larger, you have to remove it surgically.
Me: Can you explain how these fungal balls (colonization of mold in the sinus) form in the first place?
Dr. Dennis: When the immune reaction to mold occurs in the nose, a major basic protein is released. This creates pits in the lining of the sinuses. The mold anchors into these pits and begins growing, utilizing mucous as food. When this happens, the eosinophils can’t clear the mucosa to defend it. The mucus and the fungus stay in the pits, keep growing and get stacked, eventually growing into in a big ball composed of millions of fungi spores.
Me: So, when you are rinsing your nose, you are rinsing the fungus from the microscopic pits in the sinus?
Dr. Dennis: When you use a nasal rinse system in your nose, you are only washing out your nasal cavity. The saline does not necessarily get into your sinuses. In many patients, that is enough. When the fungal ball is invasive (and visible), it may require surgery, if things don’t resolve. In these cases, we open the sinuses, so that irrigation is effective in washing all of the sinuses out. It then makes it easier for the patient to proactively take care of the mold that can get in. The procedure is a same day, endoscopic surgery, and can be life changing for some patients that haven’t reached wellness.
Me: Of the patients that you treat, do many see complete recovery and a resolution of symptoms without surgery?
Dr. Dennis: Yes. Yes, definitely, if the fungus in the patient has not already badly colonized, and the patient complies to all protocol which includes leaving the moldy environment, not taking moldy belongings with them, and/or remediating the home and belongings, and consistently following the body protocol. Many will see their symptoms resolve. The benefit of surgery, when their home environment isn’t too bad, is that the patient can remain relatively well in it, if they clean, fog regularly with EC3 Mold Solution, use the EC3 candles, and have a good air purifier like an IQ Air. In other words, after surgery, even a previously sick patient can do the “Band-Aid” approach to their environment until they can move and/or remediate properly. The exceptions to this are patients with neurological symptoms. I have never seen a patient with neurological symptoms get well, unless they totally get out of the mold. This is even with surgery. These patients have to get out of the moldy environment. It is just too systemic, and they are so hypersensitive to both mold and mycotoxins that very small amounts will keep them sick . I’m referring to patients with severe cognitive impairment, motor disfunction (can’t walk or who has Parkinson’s-like twitching) from the mold affecting their brain.
Me: Which nasal antifungals do you typically utilize in your practice?
Dr. Dennis: For sprays I use amphotericin, Voriconazole, or Sporanox. I don’t use Nystatin, because it only kills Candida. I have a compounding pharmacy make the nasal drops with lidocaine to address any irritation.
Me: So, let’s address Candida, since you mentioned it. If you have mold in your sinus, does it also mean that you also have yeast overgrowth in your gut?
Dr. Dennis: The mucus from your nose does drain through the throat and into the gut. Usually, the acid in your stomach would kill it, but for mold patients who have decreased acid production and who don’t digest their food as well (almost all have acid reflux), this is definitely an issue.
Many ENT doctors do not consider acid reflux. If that is not addressed, the patient often doesn’t get better. There are several over-the counter medications that a patient can benefit from—an acid blocker, like Zantac, a good probiotic at bedtime, in combination with an anti-yeast diet work well.
The fungus in the environment has the same cell wall structure as Candida that lives in gut. So, if you become allergic to your environment, you become allergic to your own gut fungus. In order to clear the reflux permanently, you also have to clear your environment. When you living in a moldy environment and breathing in large amounts of mold in the air, you will continue to react to your gut yeast. This can mean more allergies, reflux, IBS, or leaky gut symptoms. It can be a vicious cycle.
Me: What about if the patient comes to you with both a fungal ball and a sinus infection? Do you treat a case like that the same way with antifungals? Or, is something more needed to treat the bacteria?
Dr. Dennis: The fungal air load is 5 times more important than ANY other treatment. The air load cannot be overcome with antibiotics, antifungals, surgery. That is first and foremost. As long as the mold onslaught continues through the nose, the person is not going to get well. If there is no pus—an obvious sign of infection—an antibiotic may not be required. I often prescribe CitriDrops or another natural antifungal, and strongly suggest they clear their environment of mold, and do a yeast diet. If they do that, most patients get better. If there is pus and drainage, I will prescribe an antibiotic nasal spray. I also like to prescribe taking CitriDrops Dietary Supplement orally with water, because it is known for antimicrobial and antifungal activity and works well in the gut. Also, if the patient isn’t infected, but needs some additional bacterial support, CitriDrops Nasal Spray is antimicrobial, antifungal, and is a decongestant. It’s soothing to the nasal passages too. It works for the majority of people. This cannot replace nasal rinsing with saline and CitriDrops Dietary Supplement, though. Those are two different actions. The rinsing should be done first to make treatments and sprays work better. Nothing works for everyone, though, and you have to make adjustments during the course of treatment.
Me: Thank you so much for talking to me and for sharing all of this information. I hope it will help other mold sufferers out there who are still struggling to get well.
I hope you found this interview as informative and enlightening as I did. Please comment below with any questions or email me at firstname.lastname@example.org. More information about Dr. Dennis can be found at www.sinusitiswellness.com or at www.sinussurgery.com.
Thank you for such a thorough interview and for giving us all the details. I am new to this fungal ball situation and I never want to be here again. Just had the final ball removed in the office visit… I’m happy it was done but I’m going to do everything to not be in this predicament again! Next is the evaluation/cleaning/remediation. Thank you for all the links to information and products. This is great information! Good job!
Thank you so much and thank you for reading! I did find remaining on the nasal protocol of sinus rinses, the CitriDrops Nasal Spray, and Sinus Defense continued to help me prevent reoccurrence. A mold-free environment is TOP priority, though, so stay on that track. Good luck!!!