Sitting and speaking with Diana Maffei at her dining room table, it becomes rapidly clear that she is an extraordinary young woman. She is extremely articulate, certainly wise beyond her 23 years. Ms. Maffei speaks with purpose and empathy and exudes optimism about the bright future that lies in front of her as a second-year student at the New York College of Osteopathic Medicine. Her life has been an interesting yet challenging journey, greatly influenced by the field of medicine.
At age 11, Ms. Maffei was diagnosed with cystic fibrosis, an inherited condition in which the secretory glands produce abnormally thick and sticky mucus in the lungs, causing chronic respiratory and digestive problems. Treatments for cystic fibrosis are aimed at relieving its symptoms. For Ms. Maffei, the most debilitating complication associated with her cystic fibrosis is chronic sinusitis.
“I lived with constant headaches, facial pressure and coughing,” explained Ms. Maffei. “I could never breathe properly out of my nose. And when I was first diagnosed, polyps were literally growing out of my nose. It was very difficult to breathe and sleep, since I breathed solely through my mouth for a long time.”
Ms. Maffei was referred by the Cystic Fibrosis Center at the Steven and Alexandra Cohen Children’s Medical Center of New York to Mark Shikowitz, MD, vice chairman of otolaryngology and communicative disorders and director of the Zucker Nasal and Sinus Center at Long Island Jewish (LIJ) Medical Center.
“Chronic sinus disease can pose a significant threat to patients with cystic fibrosis,” explained Dr. Shikowitz. “It’s been imperative for us to keep Ms. Maffei’s nasal passages clear since mucus can harbor bacteria and viruses and any postnasal drip can potentially infect the lungs.”
Nothing to Sneeze At
Sinusitis affects many more than cystic fibrosis patients. In fact, it strikes more than 37 million Americans, making it more common than arthritis or high blood pressure. Moreover, $7.8 billion is spent annually on the direct and indirect costs related to sinusitis in the United States. Many factors can make people more prone to sinusitis, according to Dr. Shikowitz.
An anatomical problem such as a deviated septum or nasal polyps can make people more susceptible. There is also a direct link with smoking, which irritates the lining of the sinuses, and certain systemic or chronic diseases, including cystic fibrosis and diabetes, that compromise the immune system. Congenital defects, enlarged adenoids and pediatric gastroesophageal reflux disease have been connected with sinusitis as well.
Sinusitis occurs when the cavities around the nasal passages (sinuses) become inflamed and swollen, which can impede drainage and cause mucus build-up. In addition to making it difficult to breathe through the nose, sinusitis can make the area around the eyes and face feel swollen, causing throbbing facial pain or a headache. While most people have one or two sinus infections at some point (known as acute sinusitis), chronic sinusitis is sinusitis that lasts more than eight weeks or keeps coming back.
Over the past 12 years, Ms. Maffei has undergone 14 surgeries to make her sinuses functional in order to protect her lungs, which one could say makes her a living barometer for the technological progress of sinus surgery. “My first surgery was a very traumatic experience for an 11-year-old girl,” said Ms. Maffei. “It was a major surgery, requiring an overnight stay in the hospital. I had packing in my nose, with a lot of bleeding. It took two weeks for me to fully recover and be able to return to school. And then I had my second surgery three months later and missed another week and a half of school. Being absent from school that long was very hard.”
The Good Inflation
This past November, however, Dr. Shikowitz used a special and relatively new surgical technology called balloon sinuplasty to alleviate Ms. Maffei’s sinusitis, and the differences in recovery were astonishing. Balloon sinuplasty is an endoscopic, catheter-based system that uses a small flexible balloon catheter to open blocked sinus passages, very similar to how angioplasty uses balloons to open blocked coronary arteries. Using a guide wire, Dr. Shikowitz navigates the balloon into the nose to reach the sinuses. He then inflates it to gently restructure and dilate the passageway, restoring normal sinus drainage and function without incisions to the sinus lining. There is little bleeding, and many patients can return to normal activities within 24 hours.
“I had surgery on Tuesday, November 24, and was able to eat Thanksgiving dinner only two days later with no pain medicine, no bleeding and looking a lot like myself,” said Ms. Maffei. “Some of the people at dinner didn’t even realize I had surgery.”
“Even though previous endoscopic sinus surgeries were less invasive than the open procedures we performed 20 years ago, they still entailed a lot of cutting and removing of tissue, changing the anatomy of the nasal passageway to facilitate drainage,” explained Dr. Shikowitz. “The balloon used in this new technique is so strong, when positioned and inflated, we can expand the bone and unclog the blockage in the main drainage area of the sinuses.”
In addition to Dr. Shikowitz, LIJ Medical Center and North Shore University Hospital have numerous other physicians who perform balloon sinuplasty, including Moshe Ephrat, MD, Gurston Nyquist, MD, Philip Perlman, MD, Angelo Reppucci, MD, B. Todd Schaeffer, MD, Michael Ditkoff, MD, Michael Setzen, MD, Josh Werber, MD, and Gerald Zahtz, MD.
“Balloon sinuplasty offers a real step forward in sinus surgery,” said Dr. Perlman, a community-based otolaryngologist with privileges at North Shore University Hospital. “It gives patients and their doctors a surgical option that definitely improves access to previously difficult-to-reach sinuses while minimizing discomfort and recovery time.”
Added Dr. Shikowitz, “The efficacy and safety have gone up significantly because we can visually confirm with the guide wire that the balloon is placed in the precise location of the blockage. The risk of postsurgery bleeding has greatly decreased as well. Patients are experiencing shorter recoveries and getting back to work or school sooner.”
This surgery gave a boost to Ms. Maffei’s aspirations of entering the field of medicine. For Ms. Maffei, cystic fibrosis is accompanied by growths (polyps) in the nasal passages that often regrow every 12 to 16 months. “Since this is a chronic disease for me, it’s encouraging to know that my recovery now will be so much faster, and the bleeding and pain will be better and more manageable,” said Ms. Maffei. “I feel confident that my cystic fibrosis and sinusitis are not going to hamper my life or the things I want to accomplish and enjoy. It’s a lot more controllable.”
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