Sinus Surgery Ends 10 Years of Problems

Sinus problems and sleep apnea won’t slow down this politician anymore, thanks to Riverview Medical Center’s new infrared image-guided computer system.

Sinus Surgery Ends 10 Years of Problems

Sinus problems and sleep apnea won’t slow down this politician anymore, thanks to Riverview Medical Center’s new infrared image-guided computer system.

There are plenty of things that can keep a busy executive and legislator up nights. But Joseph Azzolina’s problem wasn’t on his mind, but rather in his head – literally. The District 13 Assemblyman and president of Food Circus

Supermarkets (Foodtown) had been plagued by chronic sinus problems for over 10 years. Coping with a persistent cough, postnasal drip, facial pressure, and breathing difficulties had become a way of life for him, and previous surgeries to correct the problems were only partially successful. Even aggressive medical therapy did not work. In recent years, Joe also began to experience an increase in snoring at night and fatigue during the day. “I was coughing constantly – all day and night – and I couldn’t get rid of it,” he says. “It was really keeping me up at night.” Eventually, he underwent a sleep study, where a technician monitored him during his sleep to help identify the cause of his symptoms. The results indicated that he had obstructive sleep apnea.

A Common Sleep Disorder
Sleep apnea is the most common sleep disorder, affecting over 12 million Americans, according to the National Institutes of Health. Many people feel that an inability to get a good night’s sleep is a problem they just have to live with, but sleep apnea can cause far more serious health problems, such as high blood pressure and cardiovascular disease, memory problems, weight gain, and headaches. Accurately diagnosing the sleep apnea and undergoing appropriate treatment is extremely important.

Apnea, which is a Greek word meaning “without breath,” is a fairly accurate description of the condition because it causes a cessation of breathing for brief periods of time during sleep. Although there are three types of apnea – obstructive, central, and mixed – the most common is obstructive sleep apnea, which occurs when soft tissue at the back of the throat collapses and closes during sleep. The result is a blockage in the airway, which causes interrupted breathing and a poor quality of sleep. Over time, a continuing lack of sleep starts to affect a person’s ability to concentrate and stay awake during the day. Sleep apnea has even been linked to motor vehicle and on-the-job accidents.

The sleep study revealed that Joe had a dangerously high apnea index value of 56, meaning that while he slept, he was not breathing or, at most, breathing very shallowly, for at least 10 seconds, 56 times per hour. Frank Scaccia, M.D., an otolaryngologist (ear, nose, and throat specialist) affiliated with Riverview Medical Center, evaluated Joe and ordered a CT scan to determine the severity of Joe’s sinus condition. The scan confirmed that Joe also had persistent and significant disease with polyps and infection involving almost all of his major sinuses.

New Technology, Greater Accuracy
“Unfortunately, whenever there is scar tissue the risks of surgery become higher and the outcome becomes more unpredictable,” says Dr. Scaccia. “However, using Riverview’s new infrared image-guided computer system as a complement to our endoscopic approach, I was able to safely and effectively navigate through Joe’s sinuses and thoroughly clean out the disease.”

The entire sinus operation was done through Joe’s nose with no external incisions or post-operative swelling. In addition, specially designed straws were placed through the nose packing so that Joe could breathe through his nose right after surgery, even while the packing was in. In order to treat his snoring and sleep apnea, Dr. Scaccia also simultaneously performed an uvulopalatopharyngoplasty (UPPP), removing some of the excessive tissue in the back of Joe’s throat.

“What was great was that both the sinus problem and coughing were fixed during one successful surgery,” says Joe. “Dr. Scaccia and his surgical team made sure it was done right the first time, so I didn’t have to come back. And I can’t say enough about how wonderful the nurses were.”

After two days, the packing and straws were removed from Joe’s nose, and he was feeling much better. So much better, in fact, that he was immediately able to resume his legislative duties and made an appearance at the annual Middletown Firemen’s Picnic.

Now Sleeping Soundly
Six weeks later, Joe was almost totally healed and noted significant improvement in all of his previous symptoms, which included nasal congestion, daytime fatigue, coughing, snoring, and post-nasal drip. “Now I fall to sleep right away, and even if I have to get up for some reason, I can go back to sleep right away and sleep soundly,” adds Joe. “I’m very satisfied.”

To find an ear, nose, and throat specialist, call Meridian Physician Referral at 1-800-560-9990 or log onto Meridian’s Web site at www.meridianhealth.com.

More than a Case of the Sniffles

New technology on sinus at Meridian helps save a man with an unusual problem that was incorrectly diagnosed for years.

For almost three years, 38-year-old Jeffrey Robertson of Middletown had experienced an unusually persistent postnasal drip, a perpetually runny nose and headaches. He never went anywhere without a box of tissues; the problem was beginning to affect his life. A variety of physicians had diagnosed Jeffrey’s problem as everything from stress, to an infection, to a need for eyeglasses.

In November 1998, Jeffrey sought the medical expertise of Frank J Scaccia MD, a Riverview Medical Center ear, nose and throat specialist with a practice in Red Bank. After performing a nasal endoscopic exam, Dr Scaccia began to suspect that Jeffrey’s problem was more than an allergy or upper respiratory infection. In fact, he thought it may be a much more serious medical condition a cerebral fluid (CFS) leak.

A CT scan of Jeffrey’s sinuses and brain verified Dr Scaccia’s suspicions and further indicated that a large mass was either eroding into the sinuses from the brain or from the sinuses into the brain.

This was a very unusual presentation for a CFs leak since there was no proceeding event of trauma or surgery that would cause this, says Dr Scaccia. ‘‘Jeffrey was extremely lucky not to have developed neurological complications such as meningitis or a brain abscess considering the length of time this had been occurring.”

Riverview neurosurgeon Bruce Rosenblum MD, examined Jeffrey and his test results. Both physicians agreed that immediate surgery was necessary. Four days before Thanksgiving, Jeffrey was admitted to Riverview Medical Center for surgery.

High-Tech Surgery Close to Home
‘‘It was important for me to be at Riverview because it was close to home and my then 10-year-old daughter could visit everyday which she did,” explains Jeffrey. ‘‘Although I was confident in my physicians, we really didn’t know how the surgery would turn out and I wanted to be able to see her as often as possible. That was important to both of us.”

During the first part of the surgical procedure, called a bifrontal craniotomy, the herniated brain tissue was identified . This condition occurs when the brain tissues pushes into the sinuses and nose. Dr Rosenblum, with assistance of Dr Scaccia, separated a portion of the tissue that had decompressed into the sinus/nasal passages and restored the affected area with a section of the Jeffery’s own leg muscle. The second part of the surgery required Dr Scaccia to perform a septoplasty and endoscopic sinus surgery to remove the separated brain tissue from the nasal/sinus cavity.

One day after surgery Jeffrey was up and walking. Within just a few days he left Riverview Medical Center with out complications and or neurological consequences. Jeffrey says he feels like a new man. He has had no recurrence of the condition his breathing is better, his headaches are gone and he is back at work.

More than a Case of the Sniffles

New technology on sinus at Meridian helps save a man with an unusual problem that was incorrectly diagnosed for years.

For almost three years, 38-year-old Jeffrey Robertson of Middletown had experienced an unusually persistent postnasal drip, a perpetually runny nose and headaches. He never went anywhere without a box of tissues; the problem was beginning to affect his life. A variety of physicians had diagnosed Jeffrey’s problem as everything from stress, to an infection, to a need for eyeglasses.

In November 1998, Jeffrey sought the medical expertise of Frank J Scaccia MD, a Riverview Medical Center ear, nose and throat specialist with a practice in Red Bank. After performing a nasal endoscopic exam, Dr Scaccia began to suspect that Jeffrey’s problem was more than an allergy or upper respiratory infection. In fact, he thought it may be a much more serious medical condition a cerebral fluid (CFS) leak.

A CT scan of Jeffrey’s sinuses and brain verified Dr Scaccia’s suspicions and further indicated that a large mass was either eroding into the sinuses from the brain or from the sinuses into the brain.

This was a very unusual presentation for a CFs leak since there was no proceeding event of trauma or surgery that would cause this, says Dr Scaccia. ‘‘Jeffrey was extremely lucky not to have developed neurological complications such as meningitis or a brain abscess considering the length of time this had been occurring.”

Riverview neurosurgeon Bruce Rosenblum MD, examined Jeffrey and his test results. Both physicians agreed that immediate surgery was necessary. Four days before Thanksgiving, Jeffrey was admitted to Riverview Medical Center for surgery.

High-Tech Surgery Close to Home
‘‘It was important for me to be at Riverview because it was close to home and my then 10-year-old daughter could visit everyday which she did,” explains Jeffrey. ‘‘Although I was confident in my physicians, we really didn’t know how the surgery would turn out and I wanted to be able to see her as often as possible. That was important to both of us.”

During the first part of the surgical procedure, called a bifrontal craniotomy, the herniated brain tissue was identified . This condition occurs when the brain tissues pushes into the sinuses and nose. Dr Rosenblum, with assistance of Dr Scaccia, separated a portion of the tissue that had decompressed into the sinus/nasal passages and restored the affected area with a section of the Jeffery’s own leg muscle. The second part of the surgery required Dr Scaccia to perform a septoplasty and endoscopic sinus surgery to remove the separated brain tissue from the nasal/sinus cavity.

One day after surgery Jeffrey was up and walking. Within just a few days he left Riverview Medical Center with out complications and or neurological consequences. Jeffrey says he feels like a new man. He has had no recurrence of the condition his breathing is better, his headaches are gone and he is back at work.