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Mold sinus infection = Allergic Fungal Sinusitis?

You may have been told that your sinus infection is a “mold” sinus infection. Typically along with this explanation, you may have been told that there is no good treatment for this condition.

Allergic Fungal Sinusitis (AFS) is a very frustrating condition to treat as it is not like a typical bacterial sinus infection at all.

AFS is actually not an infection, but really an overzealous local immune response in the nasal and sinus tissue to exposure to mold.

Mold spores are very light and are floating in the air.  In patients with AFS, they breathe the mold into their nasal and sinus cavities causing an intense and exuberant short term and long term allergic inflammatory reaction.

The nasal and sinus lining develops severe swelling. This causes a blockage of the sinus outflow tracts, trapping some mold to grow and accumulate inside the sinuses. Associated pooling of sinus secretions creates a secondary bacterial infection in most cases as well.

This persistent reaction fails to respond to traditional medical treatment for sinus infection. Instead, it progresses to develop nasal polyps. These polyps are not malignant but instead, they are just extremely swollen lining that hangs into the nasal airway like large grapes.

The patient is usually miserable, with severe nasal blockage and sinus complaints, with only temporary relief with systemic steroids and antibiotics.

Even if traditional sinus surgery is done, the underlying condition is still present and the polyps tend to recur.  This causes a terrible cycle of treatment failure.

What is the modern way to successfully manage this difficult problem?

After medical therapy has failed, the following treatment algorithm gives the best chance for success:

  1. Non-surgical balloon sinuplasty and removal of polyps as an office procedure under IV sedation. Any other structural issues such as a deviated septum should be addressed at the same time.
  2. Wash out the sinus cavities (Cyclone® lavage) during the balloon sinuplasty, with a solution against inflammation, bacteria, and mold.
  3. Allergy skin test to treat common allergens with allergy drop therapy.   All 4 common mold allergens are added to the drops, even if the patient does not test positive for mold as the allergy.  This allergy can be isolated to the nasal and sinus lining and may not show on testing. These allergy drops make the patient have IgG blocking antibodies to block the allergic reaction before it occurs.
  4. Use new “biologic” treatment – Dupixent. This antibody is injected twice a month at home by the patient. It actually blocks the over-exuberant allergic response to the mold allergy by blocking certain receptor sites that are part of the allergic reaction.
  5. Examine your local home and work environment to reduce mold exposure.

With this comprehensive yet minimally invasive approach, we can have longterm success in treating this previously troublesome condition.

Schedule A Consultation

If you have been told you have AFS, come see us for a consultation and a better approach.  He will perform an in-depth evaluation and determine the best solution for you!  Contact us today at 512.601.0303 to schedule an appointment!

 

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Posted in: Allergies, Allergy Drops, Balloon Sinuplasty, Nasal Polyps, Sinus and Nasal

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