A fellow forum member made me aware of fungal sinusitis recently. I did some research on the internet, and this is what I came up with....
Sinus drainage bad breath is little more than a symptom of sinusitis, a condition where the sinuses become infected or inflamed. It can appear as a result of an infection or problems relating to fungal, allergies, viral, bacterial or autoimmune conditions. Sometimes, sinusitis may even be related to asthma attacks. Whatever the cause, sinusitis more often than not leads to sinus drainage bad breath. When there is trouble in the sinuses bad breath is caused due to very simple causes, i.e. drainage from the sinuses drips down to the back of the esophagus and onto the back of the tongue. This drainage is a high resource of protein as it has dead sinus cells that have sloughed off, blood cells, pus cells, and additional molecules formed by the body. Oral bacteria then feed of this drainage for nutrients. With a balanced and continued food supply from sinus drainage, bad breath increases along with the growing population of bacteria.
I then found an article in which the Mayo Clinic found a high number of sinusitis patients tested positive for fungal infections in their sinuses.
An article published in the Mayo Clinic Proceedings in September, 1999 by the Mayo Clinic suggests that fungal sinusitis may be much more common than previously thought. The disease is now know as EFRS (eosinophilic fungal rhinosinusitis) or EMRS (eosinophilic mucinous rhinosinusitis).
Fungal growth was found in washings from the sinuses in 96% of patients with chronic sinusitis. Normal controls had almost as much growth, the difference being that those patients with chronic sinusitis had eosinophiles ( a type of white blood cell involved in allergic and other reactions) which had become activated. As a result of the activation, the eosinophiles released a product called MBP (Major Basic Protein) into the mucus which attacks and kills the fungus but is very irritating to the lining of the sinuses. We believe that MBP injures the lining of the sinuses and allows the bacteria to proliferate.
The injury to the lining of the sinuses by the fungus and mucus led to the belief that treatment of chronic sinusitis should be directed at the fungus rather than the bacteria. Obviously the optimal treatment would address the reason the eosinophiles attack the fungus, however, at the present time, we do not know the reason.
There has been much speculation about why people develop the sensitivity to fungi. Some people believe that it is as a result of extensive use of antibiotics causing overgrowth of fungi. Others believe that it is the result of extensive exposure to mold and fungi in the environment, both due to water leaks from roofs and plumbing as well as more efficient homes with less air exchange. Needless to say it is important to fix leaks and repair damage immediately so that this exposure doesn't occur. None of these fully explain the problem, however.
One category of fungal sinusitis is called Fungus balls (Mycetoma)...
Fungus balls often involve the maxillary sinus and may present similarly to other causes of sinusitis including a foul smelling breath. In addition to radiological abnormalities, thick pus or a clay-like substance is found in the sinuses. There is no allergic mucin, but dense hyphae are found. There is no invasion. There is an inflammatory response in the mucosa. Upon looking into the sinus, the fungus ball can vary in size from 1 mm or smaller to a size which completely occupies the sinus. It may have a greenish-black appearance.
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