Non-Allergic Fungal Sinusitis

An ENT in Rhode Island emailed me and suggested the following treatment for polyposis:

    I came across your web page while looking for information for one of my patients (I'm an ENT in Rhode Island), and I have a couple of suggestions for you.  If you haven't heard about the fungal theory postulated by the Mayo folks, you should pursue it.  I think there is good evidence that a majority of patients with recurrent polyps have this altered immunologic response to certain mold spores (not an allergic response) and some of my patients have responded quite dramatically to antifungal nasal sprays;  you can have your ENT order a 0.2%Amphotericin nasal spray prepared by a compounding pharmacy, and use 5 puffs twice daily. My compounding pharmacy charges 45 dollars for a bottle of spray with a shelf life of 2 weeks. In Rhode Island, Blue Cross covers it while United Health Care does not. There is also a relatively new test for this disorder; it involves assessing a specimen of nasal mucous for the level of Eosinophilic Major Basic Protein.  New tests are not always covered by insurance and this one runs $270, so it may be cheaper simply to try the spray.    Your ENT probably has received some mailings re: the test, but if not you or he can contact me.  Other alternatives would include increasing your steroid nasal spray to a double dose; this is pretty safe since the sprays are minimally absorbed, and certainly safer than systemic steroids, though the benefit is not as dramatic.  You could also try adding a steroid to your nasal irrigation.  One way of doing this is to use a drug called Pulmicort; it comes  in a capsule that is inserted into an inhaler. You can open the capsule and dissolve it in 20-30cc of saline, then instill this at the end of your usual nasal irrigation.  I hope some of this is useful. Best regards.
 

    Many thanks for your note.  Please excuse my latency in acknowledging it -- I've been keeping too busy.  I am familiar with the fungal work at Mayo, and have filed it away in my "what to try next" bag of tricks if the polyps start giving me problems again.  It has been over seven years since my last sinus surgery, and my ENT found no polyps on my examination last summer.  That said, there is something besides air in my sinuses, as I know from a CT that was done for other reasons (following an episode of nonarteritic anterior ischemic optic neuropathy).  My current regimen seems to have the problem fairly well under control.  For unknown reasons I sometimes become anosmic and will use a systemic steroid to provide relief if the anosmia lasts more than several days, but I have not needed such treatment more often than once a year in recent years.  My major complaint now is nasal congestion, especially while sleeping.     Do you mind if I summarize your note on my site for others who are interested in trying a new treatment?

Hello Karl,
It certainly sounds like your sinus issues are under good control. you may feel free to use my comments as you see fit. Best regards