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Over the years I've received many questions about vegan versus kimchi that contains seafood. Are the microbes in the kimchi the same?

One reason this is an important question is because at certain stages of kimchi fermentation the beneficial bacteria Lactobacillus sakei (which treat sinusitis in many people) appears for a time. And during that time when L.sakei is present, dabbing a little kimchi juice in the nostrils helps and treats many individuals with sinusitis. Amazing, yes?

Many people prefer to treat sinusitis with vegan kimchi - which is also my personal preference. I don't want to worry about what is in the seafood used in kimchi. Therefore, it's vegan kimchi for me.

Earlier studies have suggested that even though kimchi is made with cabbage, the L. sakei grows from the surface of raw garlic used in making  the kimchi. From the M.A. Zabat et al (2018) study:

"Because kimchi is made without the use of a starter culture, the raw ingredients play a key role in establishing the bacterial community that is responsible for fermenting kimchi (Jung et al., 2011; Lee et al., 2015)".

"Large amounts of garlic are associated with more kimchi-associated LAB [lactic acid bacteria] in the final product (Lee et al., 2015)." [Note: L. sakei is one of the lactic acid bacteria in kimchi]

This is why the 2018 study, which I just read, is so interesting. The researchers found that both vegan (no seafood)and kimchi made with seafood (e.g., fish sauce) contain the same microbes after fermentation. They may have started out with different populations of microbes, but during fermentation the microbes become similar.

"We found that, despite initial differences in microbial composition between vegan and non-vegan kimchi, there was no notable difference in the final products. Ultimately, the microbial community of both vegan and non-vegan kimchi is dominated by Lactobacillaceae and Leuconostocaceae, and lacks the Enterobacteriaceae found in the fish sauce or miso paste."

Well... that's a relief. What kimchi you choose to eat and use as a sinusitis treatment is personal preference. It's all good. And yes, fermented foods such as kimchi are great for the gut microbiome. They increase gut microbial diversity (good!) and reduce inflammation.

From Physics News: Vegan and traditional kimchi have same microbes, study finds

Good news, vegans: A new study finds that kimchi made without fish products has the same type of bacteria as more traditionally made kimchi. That finding suggests that any "probiotic" benefits associated with traditional kimchi could be present in vegan versions as well. ...continue reading "Kimchi Made With Seafood and Vegan Kimchi Contain the Same Microbes"

Over the years I've talked to many people who have had sinus surgeries for chronic sinusitis, many of whom have had more than one surgery. And yet they keep suffering from chronic sinusitis for years . The big question: How many people are actually helped or cured by standard sinus surgery such as FESS (Functional Endoscopic Sinus Surgery)?

Well, I came across a study from 2016 looking at long-term sinus surgery (FESS) results on 560 adults. Three to 5 years after the FESS surgery, the results were pretty shocking - about 43.7% of persons were still suffering from chronic sinusitis (the researchers called it "uncontrolled"), 36.8% were somewhat better (partly controlled), and only 19.5% were feeling healthy (well controlled). Common sinus symptoms in the "uncontrolled" group were: headache, sleep disturbance, postnasal drip/secretions, and altered sense of smell.

The researchers mentioned another smaller study with similar results that looked at persons 12 years after FESS surgery: 47.4% still had chronic sinusitis (uncontrolled) and only 26.3% were doing well (controlled). They also concluded: "Therefore, better treatment strategies leading to higher disease control are warranted in CRS (chronic rhinosinusitis) care." 

Hello??   Instead of surgery, try focusing on the sinus microbiome by using beneficial bacteria such as L. sakei (in Lanto Sinus, kimchi). Researchers are looking at using beneficial bacteria in the future for sinusitis treatment.

The abstract or study summary from Allergy (the European Journal of Allergy and Clinical Immunology): Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre

ABSTRACT: Objectives: To study the degree of CRS control using novel EPOS control criteria at 3–5 years after a functional endoscopic sinus surgery (FESS) and correlate these data to symptoms scores. ...continue reading "Study Shows High Levels of Chronic Sinusitis After Sinus Surgery"

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It is now my eleventh year of successfully treating sinus infections with only the probiotic Lactobacillus sakei. This includes regular sinus infections, chronic sinusitis, and even when there are just a few sinus symptoms (you know, the gradual slide toward sinusitis). No antibiotics and no antibacterials in all this time! Yes, it still feels miraculous!

Studies show that the beneficial bacteria Lactobacillus sakei occurs naturally (in tiny amounts) in healthy sinuses, but is depleted or missing in those with sinusitis. It is normal for a community of bacteria, viruses, fungi to live in the sinuses - this is the sinus microbiome.

My journey started in the winter of 2013 after reading research in late 2012 about L. sakei. I started with kimchi back then, but in the last few years I've used the product Lanto Sinus, which contains a kimchi-derived strain of Lactobacillus sakei.

Since starting this blog in 2013, I have heard from hundreds of people and the majority agree that L. sakei works great as a sinus treatment! Other probiotic species just don't work, even though they may help with some symptoms. [See Best Probiotics For Sinusitis for details on results and products used.]

Lessons Learned Over the Past Decade:

1) Lactobacillus sakei alone is enough to treat sinus infections or sinusitis. It helps with all the associated symptoms: mucus dripping down the throat (post-nasal drip), sinus pressure, sinus headaches, earaches and coughs from sinusitis, etc.

2) Using L. sakei (whether in kimchi or Lanto Sinus) should take about a minute! No fancy methods or protocols needed.

3) Only use L. sakei when needed. This means when there are sinus symptoms (e.g., lots of mucus, post nasal drip) or you're sliding towards sinusitis. No need to wait till the sinus infection is full-blown.

4) Stop using it when feeling better. Don't use it daily or as a preventive, but only when needed. There are many species of microbes living in the sinuses, so you don't want to flood the sinuses with just one species for weeks on end.

5) After using it for a few days, evaluate whether you can stop or whether you need to keep using it longer. The sinuses frequently keep improving and rebalancing after stopping L. sakei.  One can always use more if needed. ...continue reading "Ten Plus Years of Successfully Treating Sinus Infections With Probiotics"

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This month a number of persons asked me about the probiotic Lactococcus lactis (in Probiorinse) and whether it works. This product is marketed to people with sinusitis or sinus infections, with the message that it improves the sinus microbiome and sinus health. Does it?

Unfortunately, the research says no. A well-done study published last year found that the bacteria Lactococcus lactis (Probiorinse) doesn't help to improve sinus symptoms in those with sinus issues. Yes, that bacteria is found in the sinuses, but it is not a keystone bacteria (one with a big effect) in sinus health.

The study compared the Probiorinse (Lactococcus lactis) product to Xlear (xylitol) and regular saline rinses.

The researchers tested xylitol, the probiotic Lactococcus lactisand ordinary saline rinses separately for one month in a group of persons with chronic sinusitis. They found that none of these improved sinusitis symptoms or sinus microbial diversity (the sinus microbiome). In other words, there were no significant differences among the 3 groups.

Those with chronic sinus problems still had them at the end of the study, and their sinus microbiomes and symptoms were still very different from those of the healthy participants.

By the way, another study analyzed Lactoccocus lactis (using the product Probiorinse) against some strains of harmful bacteria (Pseudomonas aeruginosa) collected from persons with chronic sinusitis and found "no effect on 4 strains, a modest inhibitory effect on one strain, and a modest proliferative effect on one" (it increased this harmful strain!). Basically no effect - not a good result.

Bottom line: Stick with ordinary saline rinses to help with sinus congestion. The medical view is that saline nasal irrigation is recommended because it helps a little with nasal stuffiness or congestion, even though this effect is temporary (a few hours?). Also, try the probiotic Lactobacillus sakei, which is a keystone bacteria in the sinuses and which kills/dominates over many harmful bacteria (e.g., Staphylococcus aureus - a problem bacteria in many with sinusitis).

Excerpt from the 2021 study by Lambert PA, et al., in the medical journal  Laryngoscope Investigative Otolaryngology:  Microbiomics of irrigation with xylitol or Lactococcus lactis in chronic rhinosinusitis

No significant trends in alpha or beta diversity as a result of treatment were observed. SNOT‐22 score did not change significantly following treatment with xylitol, L. lactis, or saline. [Translation: the microbiome (alpha and beta diversity) didn't change, and symptoms (SNOT-22 score) didn't change]

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It is now 9 full years since I first started successfully treating both chronic sinusitis and regular sinus infections using only  the probiotic Lactobacillus sakei. This means no antibiotics or any other antibacterial has been used in more than 9 years! This is amazing – ten years ago I didn't believe this to be possible.

Research shows that the beneficial bacteria Lactobacillus sakei occurs naturally (in tiny amounts) in healthy sinuses, but is depleted or missing in those with sinusitis. (You know we all have a sinus microbiome - bacteria, fungi, and viruses living in the sinuses, yes?) I started by using kimchi after reading research in late 2012, but the last few years I've used the refrigerated product Lanto Sinus, which contains a kimchi-derived strain of Lactobacillus sakei. 

I have heard from hundreds of people since the blog started, and the majority agree - Lactobacillus sakei works great as a sinusitis treatment! (Other probiotic species just don't work.) [See Best Probiotics For Sinusitis for details on results and products used.]

Lessons Learned During Past 9 Years:

  1. Lactobacillus sakei alone is enough to treat sinusitis or sinus infections. Don't need fancy concoctions or fancy protocols when using it. Using it (whether in kimchi or Lanto Sinus) should take under 1 minute a day!
  2. Only use Lactobacillus sakei when needed - when there are some sinus symptoms (e.g., lots of mucus, post nasal drip) or you're sliding towards sinusitis. No need to wait till the sinus infection is full-blown.
  3. Stop using it when feeling better. Just like with antibiotics, don't take it daily and routinely, but only when needed.
  4. Use for a few days and evaluate whether you can stop or whether you need to keep using it longer. Frequently the sinuses keep improving even after stopping Lactobacillus sakei. One can always use more if needed.
  5. Lactobacillus sakei normally lives in healthy sinuses, which is why it is such an effective sinus infection treatment for so many people.
  6. Over time (whether weeks or months) a person typically needs less Lactobacillus sakei to treat sinus symptoms. The L. sakei colonizes in the sinuses - whether short-term or long-term.
  7. Swishing a product like Lanto Sinus in the mouth alone is a gentle and cautious way to use the product. Using it in the nostrils is a stronger way to use the product.
  8. Don't overdo it. Using a little bit in the nostrils (as described in Sinusitis Treatment Summary) is sufficient. Let the little buggers travel on their own throughout the sinuses!
  9. If Lactobacillus sakei works for a person, it can feel miraculous as sinusitis symptoms disappear, frequently within a few days. Others have slower improvement. Unfortunately, it doesn't work for everyone and only self-experimentation determines whether it does - after all, everyone's sinus microbiome is different.

Hopefully this offers hope to sinus infection sufferers. Good health!

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According to a recent study, two commonly available treatments for chronic sinusitis don't work. Researchers tested xylitol, the probiotic Lactococcus lactis, and ordinary saline rinses separately for one month in a group of persons with chronic sinusitis. They found that none of these improved sinusitis symptoms or sinus microbial diversity (the sinus microbiome).

Interestingly, studies find that Lactococcus lactis occurs naturally in the sinuses of some people, yet in the study it didn't seem to have healing properties (in other words, not a keystone bacteria in sinus health). The finding of xylitol not helping with sinusitis symptoms is what most people have reported to me for years - so not a surprising finding.

Plain saline rinses may temporarily improve breathing, and are especially helpful when suffering from allergies, but it has long been known that they don't treat sinusitis.

The University of Rochester Medical Center researchers had study participants doing 1 treatment (either L. lactis or xylitol nasal rinse) for 1 month, then 1 month of saline rinse alone (the "wash-out" period), and then 1 month of the other treatment rinse. So each person tried all 3 methods. Their symptoms were assessed 4 different times with the SNOT-22 symptom questionnaire [some SNOT-22 problems]. 25 persons with chronic sinusitis (and a past history of sinus surgery) were enrolled, and 10 healthy controls (no chronic sinusitis).

So what should one try if suffering from sinusitis? Try  Lactobacillus sakei (it has helped many because it is a keystone bacteria, and also kills/dominates over many harmful bacteria). However, use it only when needed (when sinusitis symptoms start to appear) and stop when feeling better.

A month of using any product, as described in this xylitol and L. lactis study, may also be too long. One month could even lead to a sinus "imbalance".

For example, a few days or 1 week of L. sakei (whether kimchi or Lanto Sinus) may be enough! No need to repeatedly flood the sinuses with 1 product - normally healthy sinuses contain multitudes of species living in balance. ...continue reading "Some Treatments Don’t Work For Sinusitis"

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Oral microbes Credit: Wikipedia

We all have millions of microbes living in our sinuses – bacteria, viruses, and fungi. This is normal.

An amazing fact is that living together are beneficial, benign, and what we normally consider harmful microbes. And this is normal. This rich and diverse community of microbes living in the sinuses is called the sinus microbiome or microbiota.

OUR SINUSES: We have 4 pairs of sinuses in our heads, which are air-filled and lined with a mucus membrane with cilia. The cilia steadily beat (700 to 800 times a minute!) in order to move mucous into the nasal cavity. Microbes live in the mucous lining.

For years it was thought that the sinuses were sterile, and a sinus infection meant that a harmful microbe (pathogen) had invaded. In the 1990s a popular view was that fungi were the cause of chronic sinusitis. But with the development of new technologies (genetic sequencing) in the last 2 decades, it was discovered that millions of all sorts of microbes live in the sinuses in both healthy and sick persons. And yes, that it was normal to have fungi in the sinuses (so that theory was dropped).

THE CURRENT VIEW: Millions of microbes live in complex communities, interact with one another, and with us (we’re their host!). In healthy persons all the microbial species are in equilibrium, and potentially harmful species are kept in check. But sometimes the communities can become disrupted and imbalanced – this is called dysbiosis.

When there is disruption (e.g., from an infection, allergies), then there can be an overgrowth or a big increase in the potentially harmful microbes living in the sinuses. This can make you more susceptible to an infection or it can result in sinusitis symptoms. (In chronic sinusitis there is an imbalanced sinus microbiome and also inflammation of the sinus mucous lining.)

Staphylococcus Credit: Wikipedia

A HEALTHY SINUS MICROBIOME: It turns out that what is a healthy sinus microbiome varies from person to person. Yes, there is a “core” sinus microbiome of species that are shared throughout the world. (For example: Corynebacterium and Staphylococcus species)

Everyone’s sinus microbiome is unique – you may have more of some species, less or none of others. Generally a heathy sinus microbiome has more richness of species and diversity, which is diminished in people with chronic sinusitis.

But guess what? Even if a person has fewer or more species – the total number of bacteria present is the same. Think of it this way – if there is an empty space, microbes will move in to occupy it.

A big surprise in the last 2 decades is that healthy sinuses have low levels of harmful microbes (e.g.  Staphylococcus aureus) coexisting with beneficial microbes. They are considered to be “opportunistic pathogens”, which means they can become harmful if the conditions are right. For example, if the sinus microbial community becomes disrupted by an infection. Which is why so many people develop sinusitis after a cold or other respiratory infection.

Most research has looked at the multitudes of bacterial species living in our sinuses. But there are also species of viruses and fungi, and much is still unknown about them. The viruses (our “virome”) can be a stable part of our microbial community or only there briefly. Healthy persons (and those with sinusitis) also have fungi living in the sinuses.

In addition, some people have archaea living in their sinuses – one-celled organisms that don’t have a cell nucleus. A minority of people have archaea in their sinuses, but it is unknown why they are there, what is their role (if any), and why only some people have them. They can also be found in the human gut.

It turns out that we all (both healthy and sick) have biofilms living on the mucus lining of the sinuses. However, research suggests that they may be a little different in healthy persons – they are smaller (microcolonies), don’t cause an inflammatory response, and are kept in check by the other microbes. (Biofilms are bacteria communities sticking to one another, and with a protective slime coating.)

Some microbes have an important role in the health of the sinus microbiome, even if they are there only in tiny amounts – these are keystone bacteria. Lactobacillus sakei is one of them (in Lanto Sinus), and research shows it s depleted in persons with chronic sinusitis.

What else influences the species of microbes in the sinus microbiome? The list includes illnesses, allergies, asthma, cigarette smoking, age of the person, antibiotics, and whether sinus surgery has been done. All these factors help explain why in both health and sickness, every person’s sinus microbiome is unique.

Bottom line: We have trillions of microbes living in our bodies, and this includes the sinus microbiome. Bacteria, viruses, fungi, and for some people also archaea. The field is still in its infancy and so we still have much to learn.

Everyone has millions of microbes living in complex communities in their sinuses. All these hundreds of species of bacteria, fungi, and viruses are the sinus microbiome or sinus microbiota. In addition, some (many?) people also have tiny organisms called archaea living in their sinuses.

What are archaea? Archaea are single-celled organisms that lack cell nuclei, and have a unique cell wall membrane. Very little is known about them, what their role is in the sinuses (that is, what are they doing there?), how do they interact with the host (the person), and whether their presence is beneficial or not.

There are only a few studies looking at archaea in humans, and while very little is known, the current view is that there are no known harmful archaea ("archaeal pathogens or parasites").

In a 2019 study, French researchers found archaea in the sinuses of 9 of their patients with chronic sinusitis - and therefore thought they were linked to disease. But unfortunately they didn't look to see if archaea are also found in the sinuses of healthy persons, thus there wasn't a comparison group. They found methanogenic archaea (the only microorganisms able to produce methane) in these nine patients, and they thought that the archaea were contributing to or causing the chronic sinusitis.

The Methanobrevibacter species they found were  M. smithii, M. oralis, and M. massiliense, of which 2 have been found in dental plaque and periodontitis lesions, and one is a gut methanogen. [Note: This means it is found in the gut and is methane producing - but that doesn't mean it is harmful.]

Finally, a more recent and comprehensive study looked at archaea and bacteria in the sinuses of both healthy persons and those with chronic sinusitis. University of Auckland researchers found that only 6 out of 70 persons (both healthy and with sinusitis) had archaea in the sinuses, and they were very low in numbers and in diversity. In those with archaea, there was a lot of variation between people. They did not see any archaea associated with chronic sinusitis.

Archaea found were from Euryarchaeota, Thaumarchaeota, and Methanobrevibacteriaceae phyla.

One can only wonder what the archaea are doing in the sinuses in those with them. Especially, as the researchers point out that archaea are characterized by a unique cell wall membrane that "assists survival in extreme conditions such as hydrothermal vents, salt lakes, anoxic and highly acidic or alkaline environments". Also, that recent studies suggest that the human immune system recognizes and can be "activated" by archaea.

Archaea. Credit: Wikipedia

Finally, studies also mention that archaea are resistant to many antibiotics (because of lack of peptidoglycan in their cell wall). It is unknown how this influences their role (if any) in human health and disease.

As you can see, much is unknown right now. Even how many people have archaea in their sinuses, and what kinds of archaea. Stay tuned.

Article by B.W. Mackenzie et al in Frontiers in Cellular Infection and Microbiology: A Novel Description of the Human Sinus Archaeome During Health and Chronic Rhinosinusitis

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This is now the 9th year of successfully using only probiotics to treat sinusitis - both chronic sinusitis and regular sinus infections. This means no antibiotics or any other antibacterial has been used in more than 8 years! This is amazing – ten years ago I didn't believe this to be possible.

We (myself and family members) have accomplished this by using the amazing probiotic (beneficial bacteria) Lactobacillus sakei. This bacteria occurs naturally (in tiny amounts) in healthy sinuses, but is depleted or missing in those with sinusitis. I started using kimchi back in 2013 after reading research. The last few years I've used the refrigerated product Lanto Sinus, which contains a kimchi-derived strain of Lactobacillus sakei. 

I have heard from hundreds of people since the blog started, and the majority agree - Lactobacillus sakei works great as a sinusitis treatment! (Other probiotic species just don't work.) [See Best Probiotics For Sinusitis for details on results and products used.]

What I've learned about Lactobacillus sakei:

  1. Only use it when needed, when there are some sinus symptoms or you're sliding towards sinusitis. Just like with antibiotics, you shouldn't take it daily and routinely.
  2. Swishing a product like Lanto Sinus in the mouth alone is a gentle and cautious way to use the product. Using it in the nostrils is a stronger way to use the product.
  3. Don't overdo it. Using a little bit in the nostrils (as described in Sinusitis Treatment Summary) is sufficient. Let the little buggers travel on their own throughout the sinuses!
  4. Use for a few days and evaluate whether you can stop or whether you need to keep using it longer. Frequently the sinuses keep improving even after stopping Lactobacillus sakei. One can always use more if needed.
  5. If Lactobacillus sakei works for a person, it can feel miraculous as sinusitis symptoms disappear, frequently within a few days. Others have slower improvement. Unfortunately, it doesn't work for everyone and only self-experimentation determines whether it does - after all, everyone's sinus microbiome is different.
  6. Lactobacillus sakei alone is enough to treat sinusitis. Don't need fancy concoctions or fancy protocols when using it. Using it should take under 1 minute a day!
  7. The sinus microbiome slowly improves, so we are using less and less of Lanto Sinus over time. There have been improvements in the sinuses – for example, this past year my snot is like it used to be decades ago before sinus problems. We are also getting fewer upper respiratory infections.
  8. My sense is that Lactobacillus sakei is colonizing in the sinuses, at least in the short term (weeks or months).

Hopefully this offers hope to sinus infection sufferers.

I also want to mention that I'm a consultant for Lanto Health, but that's because I really like the product and use it whenever needed.

Good health!

The relationship between mold and sinuses is something I've been thinking about lately. Why do so many people after prolonged exposure to ordinary mold eventually develop sinusitis? What is going on?

This is a really interesting question because we are exposed to mold (which is actually fungi) every single day just from ordinary breathing. Fungi are all around us - in the wind, in the air, in the soil, and we always have a little in our homes. For example, in the bathroom tub or shower area, in moldy food, or around the kitchen sink. These are common molds. And we're normally just fine.

In addition, we all have some fungal species living in and on our bodies, and they are part of the normal human microbiome (the community of bacteria, fungi, and viruses living on and in us). In fact, different species of fungi live in different parts of our body, even some species that we tend to think of as harmful, such as yeast and Aspergillus. In a healthy person, any potentially harmful microbes are kept in check by the other microbes in the microbiome so that they are living there harmlessly.

Yes, sometimes fungi can multiply to the point of doing harm (such as during a fungal skin infection, e.g. athlete's foot) or in an immunocompromised person, but normally fungal species live in a complex ecosystem in harmony with all our other millions of microbes.

Ordinary common molds can sometimes cause problems

But sometimes people get exposed to a lot of ordinary or common molds over a prolonged period of time. And this is where problems can develop if they breathe in a lot of the fungi.

The most important thing to know is that fungi (mold) grow in wet or moist conditions. Especially where it is not well ventilated. For example, when air conditioning systems that are not draining properly result in mold growing in the unit and the ducts. Or a water leak from the roof causes mold to grow on a wall or ceiling right in your bedroom. In both cases people are breathing it in for prolonged periods.

What kind of health problems can result? The health problems from common molds are generally of an inflammatory  or allergic nature, such as respiratory symptoms, respiratory illnesses (sinus infections), asthma, allergic responses, immunological, and other inflammatory responses. [This is according to CDC (Centers for Disease Control and Prevention), WHO, and other major associations.]

But here's another thing - responses to large mold exposure vary, with some people having big responses (respiratory infections or asthma), some minor (perhaps drippy nose), and some no effects at all.

The good news is that more extreme health effects from mold exposure are very rare according to the CDC, the World Health organization, and some other health groups, with only some individual cases reported. Whew.

Looking back on my own history of sinus infections, it all makes perfect sense! After developing non-stop sinus infections years ago, I went to an ENT specialist who, after careful examination of my nasal passages, said that I was showing a massive inflammatory response, an allergic response. And only when I figure out what was causing the allergic response would I start to improve. Which turned out to be true.

[NOTE: This post is not going into the issue of mycotoxins (of fungi that release toxins), and of molds that take over houses making them uninhabitable, for example after floods.]

Deal With A Mold Problem As Soon As Possible

The CDC says don't bother with blood tests for mold - there aren't any. There are only tests that look at allergic responses to mold. And don't worry about what type of mold is in the house. Just clean it up, replace what needs replacing, make repairs, fix whatever needs fixing, etc. as soon as possible.

Once the mold problem is fixed and mold removed, the mold exposure is gone. And any health symptoms related to too much mold exposure health can finally improve.

Final thoughts about mold and sinusitis: For a while in the 1990s it was thought that people with sinusitis all had fungal problems in the sinuses and sinusitis should be treated with antifungals. Nope. When genetic sequencing tests were developed, researchers discovered hundreds of microbial species in healthy and sick people - and they realized that we all had fungi as part of our microbiome.

Which is why physicians now generally view sinusitis as an "inflammatory process", maybe due to an allergic response. Fungal sinusitis is considered one type of sinusitis, and only in a small minority of sinusitis cases.

Indoor mold by window Credit: Wikipedia