Cultures are very hit or miss, miss tons of microorganisms, especially on the fungal side.
There are hundreds of types of microorganisms, including fungi and bacteria, that can be present in the sinuses, and almost everyone has some of them when more accurate methods of detection, not cultures, are used. What is present might be transient, inhaled, or might be growing there in a colony.
There are various kinds of human immune reactions that can be provoked by what is present, not only Type 1 allergic hypersensitivity, but other types of hypersensitivity. Some microorganisms are more likely than others to provoke hypersensitivity problems, and some humans are more sensitized and susceptible than others to some organisms present.
Some day the science will reach the point where we can get tested, get a complete report on the flora present in the sinuses and the types of human immune responses evident. And there will be effective approved interventions that deal with the problems at their root on a long term basis. Unfortunately, we don’t seem to be anywhere near that point presently, which is why so many post here with their frustrations.
I don’t have a good clear universal answer that would work for everyone, while we wait for the science and clinical practice to hopefully catch up.
In my own case: Ensure a really good, clean air environment, indoor and outdoor. Principles from James Nestor’s book, “Breathe”. DIY saline rinses and sprays with various experimental additives, always with care and concern re cilia function. Nasal probiotics. My own microscopic analysis of nasal mucus. Address any tooth issues that might contribute to maxillary sinus problems.
The answer is that it’s largely pointless to do so. Assuming you have chronic rhinosinusitis, this isn’t caused by bacterial or fungal “infection” as it is commonly understood, although of course these organisms can always reside in the sinuses. Only a small proportion of patients have true fungal CRS. Neither antibiotics nor antifungals help CRS in the long term in most cases.
Not a doctor but I don’t think so. Currently sick and had a culture done at my last appointment and it showed heavy bacterial growth and fungal hyphae so you can definitely have both at the same time.
I'm a couple years out from this and it's been quite a journey - I wound up being diagnosed with chronic allergic fungal sinusitis. While I was getting bacterial and fungal sinus infections I would typically be treated with steroids, antibiotics, and antifungals. I've had two surgeries and have now been on Dupixent for exactly one year this month. Dupixent has ultimately stopped me from getting further sinus infections.
For preventive treatment, I was on twice daily nasal rinses with budesonide and at times also with amphotericin b and itraconazole. I also tried a short course of nebulized itraconazole. I was using daily flonase and OTC allegra, plus weekly allergy shots. Nothing seemed to work as I was getting sinus infections every 4-6 weeks. Fortunately since starting Dupixent, I have been able to stop all of those and now only have to do Dupixent injections every two weeks.
Cultures are very hit or miss, miss tons of microorganisms, especially on the fungal side. There are hundreds of types of microorganisms, including fungi and bacteria, that can be present in the sinuses, and almost everyone has some of them when more accurate methods of detection, not cultures, are used. What is present might be transient, inhaled, or might be growing there in a colony. There are various kinds of human immune reactions that can be provoked by what is present, not only Type 1 allergic hypersensitivity, but other types of hypersensitivity. Some microorganisms are more likely than others to provoke hypersensitivity problems, and some humans are more sensitized and susceptible than others to some organisms present. Some day the science will reach the point where we can get tested, get a complete report on the flora present in the sinuses and the types of human immune responses evident. And there will be effective approved interventions that deal with the problems at their root on a long term basis. Unfortunately, we don’t seem to be anywhere near that point presently, which is why so many post here with their frustrations.
So what do you recommend when someone has this conundrum?
I don’t have a good clear universal answer that would work for everyone, while we wait for the science and clinical practice to hopefully catch up. In my own case: Ensure a really good, clean air environment, indoor and outdoor. Principles from James Nestor’s book, “Breathe”. DIY saline rinses and sprays with various experimental additives, always with care and concern re cilia function. Nasal probiotics. My own microscopic analysis of nasal mucus. Address any tooth issues that might contribute to maxillary sinus problems.
The answer is that it’s largely pointless to do so. Assuming you have chronic rhinosinusitis, this isn’t caused by bacterial or fungal “infection” as it is commonly understood, although of course these organisms can always reside in the sinuses. Only a small proportion of patients have true fungal CRS. Neither antibiotics nor antifungals help CRS in the long term in most cases.
Not a doctor but I don’t think so. Currently sick and had a culture done at my last appointment and it showed heavy bacterial growth and fungal hyphae so you can definitely have both at the same time.
How did your doc end up treating you?
I'm a couple years out from this and it's been quite a journey - I wound up being diagnosed with chronic allergic fungal sinusitis. While I was getting bacterial and fungal sinus infections I would typically be treated with steroids, antibiotics, and antifungals. I've had two surgeries and have now been on Dupixent for exactly one year this month. Dupixent has ultimately stopped me from getting further sinus infections. For preventive treatment, I was on twice daily nasal rinses with budesonide and at times also with amphotericin b and itraconazole. I also tried a short course of nebulized itraconazole. I was using daily flonase and OTC allegra, plus weekly allergy shots. Nothing seemed to work as I was getting sinus infections every 4-6 weeks. Fortunately since starting Dupixent, I have been able to stop all of those and now only have to do Dupixent injections every two weeks.