Chronic Sinusitis by Devin J. Starlanyl

Discussion in 'Fibromyalgia Main Forum' started by lenasvn, Mar 19, 2006.

  1. lenasvn

    lenasvn New Member

    Here comes some info on Chronic Sinuitis which I know many of us suffer from and wonder about.

    Chronic Sinusitis: A Major Perpetuating Factor?
    by Devin J. Starlanyl

    This information may be freely copied and distributed only if unaltered,
    with complete original content including: © Devin Starlanyl, 1995-1999.

    Chronic Sinusitis: A Common Perpetuating Factor?

    In far too many instances, in my opinion, researchers have found one potential
    initiating or perpetuating factor associated with fibromyalgia syndrome (FMS) and
    assume that they have found THE CAUSE or THE CURE. In most cases, the
    development of FMS or full-blown bodywide chronic myofascial pain (CMP) is
    multifactorial. There may be a heterogeneous collection of factors that initiate
    and/or perpetuate the central sensitization if it is FMS. I have found that the key
    to success in dealing with FMS, just as in dealing with CMP, is to identify as many
    perpetuating factors as possible and control them as much as possible. I think I
    have found a hitherto unsuspected cause of, or at least contributor to, some cases
    of central sensitization, and perhaps a successful therapy for it.

    Research indicates that FMS may be central nervous system (CNS) sensitization
    resulting from an immune response leading to spinal glial activation (Staud
    2004). At the Focus on Pain (Travell) Seminar in Orlando, Florida, in 2003, Dr.
    Linda Watkins, Director of the Interdepartmental Neuroscience PhD program,
    explained her research at the University of Colorado in Boulder. Her team is
    investigating the onset of chronic pain and the mechanism causing central
    sensitization. They have found that the CNS can be sensitized by many factors,
    including infection and trauma, but the key to the sensitization is the activation of
    spinal glial cells. [More on Dr. Watkins’ presentation is found elsewhere on the
    Focus on Pain handout on this website.]

    A team lead by Joyce DeLeo, MD, at Dartmouth-Hitchcock Medical Center in
    Lebanon, NH, found that the CNS neuroimmunological cascade response leading
    to chronic pain states may also be linked to opioid tolerance (DeLeo, Tanga,
    Tawfik 2004). They found that the changes in CNS glial cells and
    proinflammatory cytokines that contribute to central sensitization can decrease
    the effectiveness of opioid medications. This team also found that
    neuroinflammation and interstitial swelling can be integral parts of central
    sensitization. I have found that interstitial swelling can be tied to pain levels in
    some patients with FMS and CMP. Also of interest is their observation of cellular
    adhesion molecules in the lumbar spinal cord following peripheral inflammatory
    stimuli. This may indicate a similar process occurring in the central nervous
    system similar to the myofascial cellular adhesion in response to mechanical or
    biochemical trauma. This team provided another piece of the puzzle.

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 1

    Another piece, and a big one, came with the presentation of a paper on March 23,
    2004, at the annual meeting of the American Academy of Allergy, Asthma and
    Immunology in San Francisco.

    A Mayo Clinic team of physicians lead by David A. Sherris found that airborne
    fungi commonly found in the mucus linings of the sinuses can adversely affect
    individuals prone to chronic sinusitis. These fungi provoke an immune response,
    which in turn attacks the fungi, resulting in symptoms of chronic sinusitis. Could
    this immune response provoke central sensitization? The team ran a placebo-
    controlled, double blind pilot study using Amphotericin-B intranasally. Seventy
    percent of the linings of the sinus membranes of those patients on the drug
    decreased in thickness, and the symptoms abated. Approaching chronic sinusitis
    as an immune disorder creates a different perspective.

    Dr. Sherris, now interim chair of the University of Buffalo Department of Otolaryngology,
    is using the Amphotericin B nasal spray the team used on his patients.
    He reports on WebMD that this study may indicate the first ever treatment for the
    cause of chronic sinusitis, rather than a symptomatic approach.

    In 1992, an article linked chronic rhinitis to FMS (Cleveland, Fisher, Brestel, et al.
    1992). This team studied 47 consecutive patients with allergic rhinitis in a general
    allergy clinic and found congestion in 91%, rhinitis in 87% and postnasal drip
    in 83%. Forty-nine percent met the ACR criteria for FMS, and the team concluded:
    “ associated with fibromyalgia and may be an underdiagnosed
    but important causative factor.”

    One review shows how neurogenic mechanisms can complicate sinusitis (Baraniuk
    2001). Stimulation of nasal sensory nerves leads to pain and congestion. Pain
    receptors cause release of substance P, stimulating mucosal defense mechanisms.
    Sympathetic dysfunction then can cause sinuses to fill and the mucosal lining to
    thicken. Fibromyalgia is associated with sympathetic hypersensitivity.

    I have been working on a review of 200 patient interviews picked at random from
    over 1000 interviews done between 1992 through 1999. [This review will be
    posted on the website.] These patients had diagnosed or suspected FMS and/or
    CMP. The patient interviews were reviewed to identify and assess possible symptom
    clusters and patterns. Almost all of the patients had at least one myofascial
    trigger point (TrP), and most of the patients had either CMP or a combination of
    FMS and numerous TrPs. Of the 200 patients, only 11 patients did not have
    either FMS or CMP. The most common symptom listed was post-nasal drip. Of
    the 189 patients with either FMS and/or CMP, all 189 had post nasal drip. This
    result was unexpected. The post nasal drip was frequently accompanied by sinus
    congestion and runny nose.

    Specific head and neck TrPs can cause drippy nose and congestion. Trigger points
    in the sternocleidomastoid muscles (SCM) alone can cause, among other things,

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 2

    coordination problems, proprioceptor dysfunction, dizziness, imbalance, neck
    soreness, a swollen-glands feeling, runny nose, maxillary sinus congestion,
    tension headaches, eye problems (tearing, blurred or double vision, inability to
    raise the upper eyelid, dimming of perceived light intensity), spatial disorientation,
    postural dizziness, vertigo and nerve impingement (Simons, Travell,
    Simons 1999). Many of these symptoms mimic chronic sinusitis. A picture was

    Late in 2003 I had been given another piece of the puzzle, although I didn’t know
    it at the time.

    I met with Lawrence Funt, DDS, MSD, Director of the CranioFascial Pain Center in
    Bethesda, MD. During an afternoon together, we discussed Janet Travell and the
    founding of myofascial medicine. We also discussed the Funt-Symptom Index
    (Funt 1988). During the course of a long career in pain management, Dr. Funt
    had noticed patterns of symptoms that occurred in patients in sequence, according
    to age and length of pain history. His patients between the ages of 4 and
    6 years experienced clenching of the jaw, stuffy ears and headaches. Symptoms
    progressed, and by age 21 to 30 there appeared, among other symptoms, maxillary
    sinus pain that became increasingly frequent. This later fit into the puzzle.
    We also spoke of biofilms.

    Biofilms are becoming increasingly important in medicine, science and technology.
    Bacteria and other organisms have developed a successful survival strategy.
    They grow in a slimy mass, covering themselves with protective polysaccharides.
    These biofilms develop on the surfaces of medical devices, in air and water
    treatment systems, and in human bodies. Organisms in biofilms are remarkably
    resistant to anything you throw at them. Counter agents need to get through the
    slime and kill all the organisms, or the buggies just multiply themselves right
    back, often with a resistance to the first counteragent used against them. The
    July 4, 2003, edition of Science gave a good description of biofilms as a community,
    with a layer of slime covering “...the entire community, protecting it from
    attacks by the body’s immune system.” That piece fingered biofilms as the culprit
    in bladder infections. Osteomyelitis, Cystic Fibrosis, prostatitis, and middle ear
    infections are biofilm infections (Costerton 1998).

    Organisms in biofilms are protected against antibacterial chemicals and environmental
    predators. Nutrient limitations and the build-up of toxic metabolites favor
    the formation of biofilms (Donlon, Costerton 2002). This occurs often in FMS
    (Starlanyl and Copeland 2001) and in the area of a myofascial TrP (Simons,
    Travell, Simons 1999). Biofilms are associated with increased fibronectin, coaggregation
    and adhesions, and the production of endotoxins. Biofilms can also be
    formed by mycobacteria (Hall-Stoodley, Keevil, Lappin-Scott 1999). Organisms
    forming biofilms are resistant critters. They could be perpetuating factors in a
    number of cases of FMS and CMP.

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 3

    Some of my review patients with long-standing symptoms had mentioned childhood
    dental problems. Others recalled frequent bouts of sinusitis and earaches.
    Sternocleidomastoid TrPs are common and cause a lot of symptoms that can be
    mistaken for sinusitis. Trigger points in the longus colli muscle can cause sore
    throat, persistent tickle in throat, and a lump in throat. Deep anterior neck
    muscles can refer to the laryngeal area. Cricoarytenoid TrPs cause regional
    muscle pain on talking, and a sore throat. Other TrPs can be responsible for ear
    pain, stuffiness of the ear, and temporary hearing impairment. One study found
    that of 111 patients with suspected chronic maxillary sinusitis, only 56% had that
    diagnosis verified. In 61 % of the patients in whom it could not be verified,
    dental infections and/or myofascial pain were the most common cause (Lindahl,
    Lelen, Ekedahl 1982). Possible patterns were emerging.

    Chronic sinusitis (or its symptoms) is frequently treated by antibiotics. Patients
    often reported frequent antibiotic use during periods of their lives. The use of
    antibiotics would enhance fungal problems, although they might reduce congestion
    if there were a secondary bacterial infection. The drippy nose and congestion
    would return, because the fungi and immune response would remain.

    Patients often mentioned chronic yeast infections. Women especially reported
    this, although some men and boys also mentioned gastrointestinal yeast problems
    or thrush. Many patients also had symptoms of reactive hypoglycemia or
    insulin resistance. Insulin resistant states provide a fertile home for fungi and
    yeasts. A subset of patients also reported mold sensitivity, although this was not
    one of the parameters of the review. Several patients also reported treatment
    with antifungals Nystatin and/or Diflucan. Some required Nystatin to be administered
    concurrently with any antibiotic therapy to avoid further yeast infection.
    Sensations of CNS swelling were reported, often linked with cognitive deficits.
    Some mentioned these worsened when sweets or other heavy carbohydrate meals
    were eaten, and some described easing of these symptoms with use of diuretics
    and/or higher protein diets.

    Nystatin works in the gastrointestinal system to destroy yeast there. Diflucan
    works systemically, but what about the blood-brain barrier? This protective barrier
    prevents molecules from crossing over to the CNS. It is also a pesky obstacle
    to effective therapy of the CNS, as many medications can’t cross it. What if an
    immune response to fungi, possibly in biofilm, were a common instigating or perpetuating
    factor of central sensitization? Why would the Amphotericin B nasal
    spray used by Dr. Sheris and his team work better than Diflucan? Enter the last
    piece of the puzzle — I needed to try an experiment on my own.

    Dr. Gunter Oberdörster and his team have conducted a study to see if an inhaled
    ultrafine particle could cross along the olfactory nerve into the olfactory bulb
    (Oberdörster, Sharp, Atudorie, et al 2004). They found that a particle could move
    into the CNS from the nasopharyngeal area. The study is not yet published but is
    in press and is available on the web. It was done on ultrafine particulates, but it

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 4

    indicates to me that a nasal spray might have a better chance of reaching the
    CNS and any fungi within.

    The puzzle, while by no means complete, gave me enough for action. I was still
    hesitant, because Amphotericin B is not a medication to be used lightly. I had no
    experience with it as a nasal spray. I called my compounding pharmacist, George
    Roentsch, at The Apothecary in Keene, NH. He told me that compounded Amphotericin
    B nasal spray was generally used at 20 mcg/ml, required refrigeration and
    had a short shelf life, but his experience was that the spray used 5 times a day in
    each nostril for two weeks was sufficient to bring relief of symptoms without side
    effects. I spoke with my primary care physician and my allergist as well as my
    local myofascial trigger point doctor. With my history of severe FMS and CMP,
    plus Metabolic Syndrome, sleep apnea, a long history of mold and yeast allergies,
    immune therapy for multiple fungi, and frequent interstitial swelling, they agreed
    that I seemed like a good candidate for this therapy. I had other allergies and
    knew that this would do nothing for them, but I hoped that any CNS mold component
    and associated immune response might be brought under control.

    I first went on a course of Diflucan therapy, with no change in symptoms. After
    allowing my body recovery time from the Diflucan, I went on the Ampho B nasal
    spray for 2 weeks. The deep congestion that I hadn’t been able to relieve since
    they took PPA (original Contac formula) off the market went away. The fluids in
    my body tissues are rearranging themselves. The TrPs are becoming more available
    to treatment, although I noted a phenomenon that others have reported.

    As the central sensitization lessened, the TrP symptoms became more noticeable.
    The increase in myofascial pain was considerable at first, but I have TrPs in
    almost every layer of every muscle. My myofascia is unwinding, satellite and
    secondary TrPs are being eliminated, and bones are shifting back into a more
    normal position. This is not a comfortable process, but it is a necessary one to
    resume a higher standard of health. My pain level is down with less medication.
    I believe that one perpetuating factor in my life has been found and brought
    under control, at least somewhat. I have multiple allergies and the symptoms
    were further aggravating several of my medical conditions. After further research,
    I decided to go for retesting and resumed allergy shots.”

    My blood levels are regularly monitored by Dr. Lynne August at Health Equations.
    We had been unable to get the cholesterol and triglycerides down with diet alone,
    and my health team agreed that the cholesterol could well be protecting me from
    something and I did not wish to return to cholesterol medications. After the
    Ampho B nasal spray therapy, my triglycerides dropped from 261 to 155, my
    cholesterol dropped from 350 to 287, my cholesterol/HDL ratio normalized, and
    the toxin load dropped. This is only one test, but the only thing that changed was
    the nasal spray therapy. Time and later blood testing will tell if the Metabolic
    Syndrome can be taken off my co-existing conditions (and perpetuating factors).
    This is all very recent, and I don’t know where my health level will stabilize. I

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 5

    know that there are other hidden perpetuating factors. The good thing about that
    is when a perpetuating factor is found, something can often be done. It just
    takes a little detective work and the right pieces of the puzzle.

    This therapy is not a cure for FMS or CMP. Chronic sinusitis caused by an immune
    reaction to fungi may be part of the central sensitization process in some cases of
    FMS. It may be a perpetuating factor in CMP. We still don’t know how safe this
    therapy is.

    This is all very new. It will take time and money for researchers to provide these
    answers. If patients have an indicative history, such as frequent yeast infections,
    reactive hypoglycemia or insulin resistance, mold sensitivity, resistant congestion
    and post nasal drip, I believe that this is a therapy that is worth considering.


    Baraniuk JN. 2001. Neurogenic mechanisms in rhinosinusitis. Curr Allergy
    Asthma Rep 1(3):252-261.

    Cleveland CH Jr, Fisher RH, Brestel EP et al. 1992. Chronic rhinitis: an under-
    recognized association with fibromyalgia. Allergy Proc 13(5):263-267.

    Costerton JW. 1998. Biofilms...A Growing Problem. Seminar: Center for Biofilm
    Engineering. Maunco Seminars. [

    DeLeo JA, Tanga FY, Tawfik VL. 2004. Neuroimmune activation and neuroinflammation
    in chronic pain and opioid tolerance/hyperalgesia. Neuroscientist

    Donlan RM, Costerton JW. 2002. Biofilms: Survival Mechanisms of Clinically
    Relevant Microorganisms. Clin Microbio Rev Apr p. 167-193.

    Funt LA. 1988. The pain doctors: the evolution of pain practice. Interview by
    Drs. John Herald and Michael P. Pecenka. Dent Manage 28(9):60-64, 66.

    Hall-Stoodley L, Keevil CW, Lappin-Scott HM. 1999. Mycobacterium fortuitum and
    mycobacterium chelonae biofilm formation under high and low nutrient
    conditions. J Appl Microbiol Symposium Suppl. 85:60S-69S.

    Lindahl L, Melen I, Ekedahl C et al. 1982. Chronic maxillary sinusitis. Differential
    diagnosis and genesis. Acta Otolaryngol 93(1-2):147-150.

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 6

    Oberdörster G, Sharp Z, Atudorei V et al 2004. Translocation of inhaled ultrafine
    particles to the brain. Inhalation Toxicol (in press).

    Simons DG , Travell JG, Simons LS. “Myofascial Pain and Dysfunction: The
    Trigger Point Manual”, vol I, edition 2. Baltimore, MD: Williams and Wilkins;1999.

    Starlanyl DJ and Copeland ME. 2001. Fibromyalgia and Myofascial Pain: A Survival Manual edition 2. Oakland CA: New Harbinger Publications.

    Staud R. 2004. Fibromyalgia pain: do we know the source? Curr Opin Rheumatol

    Chronic Sinusitis: A Common Perpetuating Factor?
    by Devin J. Starlanyl © 2004 Page 7

  2. msmac

    msmac New Member

    This is very interesting. Thanks so much for the post! I have always been interested in new out of Dartmouth, as I am from Central Vermont originally. There is some great stuff coming out of there, and UVM.
  3. lenasvn

    lenasvn New Member

    Prickles, I'm so happy you're happy!

    I am glad I found it too. My mom and me both had this problem for ages. This all gives an explanation!
  4. lenasvn

    lenasvn New Member

  5. NyroFan

    NyroFan New Member


    Very interesting. Good post!

  6. victoria

    victoria New Member

    I tried myofascial release, however, and it didn't help at all after spending almost $1,000 out of pocket -

    but I'd say still it was definitely worth a try!

    so here's a bump!


    PS I think I've tried just about everything including allergen free diets of all kinds to no avail over the long run.

    The only thing I haven't tried is something like an amphoterecin nasal spray (antifungal), still looking for a doctor to RX it on trial, can be gotten thru certain pharmacies.

    [This Message was Edited on 05/08/2006]
  7. place

    place New Member

    Me too. I really made 80% when I cleaned up my diet and stopped eating wheat, soy, corn, eggs and milk. After 2-3 years of avoiding these foods, I am able to add them back in a little.

    If I overdo it with the food, I get a reaction!
  8. place

    place New Member

    Me too. I really made 80% when I cleaned up my diet and stopped eating wheat, soy, corn, eggs and milk. After 2-3 years of avoiding these foods, I am able to add them back in a little.

    If I overdo it with the food, I get a reaction!
  9. KMD90603

    KMD90603 New Member

    Very interesting article. I constantly had sinus infections as a kid. Then, in my later teen years, they pretty much stopped. My symptoms of FMS and CFIDS began after my son was born 5 years ago. About 2 years ago, I began having problems with sinus infections again. I've wondered if many of my symptoms were caused by chronic sinusitus, or if somehow the the sinusitis is yet another part of FMS/CFIDS.

    Thanks again. Gentle healing hugs,
  10. sleepyinlalaland

    sleepyinlalaland New Member

    but very interesting.

    As a "lifer", I know that very early on I had chronic sinus problems (still remember a dreadful kindergarten teacher mimicing my snuffling for the class!). I had stuffy sinuses for a few years.

    Went on to develop sleep problems, childhood migraines, costochondritis, TMJ, blah, blah. But it could have all been preceded by those earlier years of sinusitis.

  11. sues1

    sues1 New Member

    Thanks for this posting......I also wanted to bump this/
  12. Bruin63

    Bruin63 Member

    Dr. Starlanyl also has a website, that you can use to print out Information, for your Doctor's, PT's, Pharmacist, etc.

    I have copies, that I keep on hand for when I have to go see a new Doctor, because I sometimes get tounge tied, and can't explain myself as well.

    I found her Books right after being dx with FMS.
    I had the dx of Chronic Myofasical Pain Disorder.
    It really explained it so that even my pea brain could understand it.

    Can We ever understand it totally?

    The TrG SCM is my main Problem, and it will never go away, due to the Damage that was done to me during a Cervical Surgery, on the C-7.

    It now cause's me to have pain in the Jaw as well.

    So even tho I may have TMJ Symptoms, I don't have TMJ, but I do have Sinusitis, Mastoiditis, and Spinal Stenosis, with dics 3/4/5/6 collapsing. (sorry about the lousy sp)
    They all are linked, and the Pain will never stop, so I needed to know, how to Treat the CMPD.

    Dr. Starlanyls Book helped me the most with learning the Difference in the two Conditions.

    You might want to check out her website , just google in her name, and check out the Trigger Points, of the Different area's of the body.

    She also has an article, you can find on the Home page here.

    I have always believed, that many , have CMPD, as their Main Condition, then the Fibromyalgia, adds to the pain.
    It's a Pain Sensitive Amplification Syndrome.
    Togeather they are Miserable,.

  13. shelbo

    shelbo New Member

  14. jaltair

    jaltair New Member

    I'm going in to see my allergist because of my chronic sinus situation tomorrow and will share this with him. I wonder if amphotericin B is available in a nose spray through an RX for use now? I'll be sure to ask him. I know that he'll be really interested.