Tracheal schwannoma: a misleading entity

Primary tracheal tumors are rare with the majority being malignant. Benign lesions are less frequent with primary tracheal schwannomas accounting for less than 0.5% of tracheal tumors. They are more common in females and their clinical presentation is non-specific. Chronic cough, progressive respiratory distress and even asthma-like conditions prevail as presenting symptoms and signs. Laryngotracheal endoscopy reveals a solitary, well encapsulated mass arising most often from the posterior tracheal wall. The diagnosis of tracheal schwannomas is primarily pathological. Endoscopic excision, sleeve excision or tracheal resection, are all commonly accepted treatment modalities. Proper awarness of these lesions is crucial in the pre-operative work-up of patients presenting with stridor

Laryngeal involvement in rheumatoid arthritis

Patient with rheumatoid arthritis should be screened prior to surgery for any laryngeal manifestation. A thorough history and physical examination coupled with indirect or direct laryngoscopy are mandatory. Nonspecific laryngeal symptoms in patients with rheumatoid arthritis should raise suspicion of laryngeal involvement. Phonatory disturbances or airway difficulties may reflect advanced stages of the disease. Their presence is usually coupled with high resolution computerized tomography findings. Aggressive therapy should be started and corticosteroid injection should be contemplated in cases of failure of conventional treatment. The anesthesiologist should handle with extreme care the inflamed laryngeal structures and be least aggressive in securing the airway

Persistant dysphonia following endotracheal intubation

Voice production is a complex process that involves more than one system, yet most causes of dysphonia are attributed to disturbances in the laryngeal structures and little attention is paid to extralaryngeal factors. Persistent dysphonia after general anesthesia is a challenge to both anesthesiologists and otolaryngologists. The etiology is often multivariable and necessitates a team approach for proper diagnosis. Laryngeal symptoms are subdivided into phonatory disturbances and airway related complaints. When they become persistent for more than 72 hours or are coupled with airway symptoms such as hemoptysis, stridor, dyspnea or aspiration, the anesthesiologist should suspect injury to the vocal folds or cricoarytenoid joints. Here-below, the laryngeal manifestations of endotracheal intubation and the pathophysiology of vocal fold scarring are discussed

Treatment of primary atrophic rhinitis with intranasal honey spray

Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of the mucosa and underlying bone of the turbinates and the presence of a viscid secretion which rapidly dries and forms crusts which emit a characteristic foul odor sometimes called ozaena; there is abnormal patency of the nasal passages. The study was conducted on 32 patients with age range [14- 30] years, all patients included in this study suffered primary atrophic rhinitis with the classic symptoms of nasal crusts, ozenea and roomy nose, all were subjected to history taking, endoscopic examination of the nose and a histopathological examination of a specimen obtained from the inferior concha, and VDRL testing prior to therapy. Honey sprays were prepared by the patient daily as a solution of 2:1 in distilled water and packed into a sprayer that used by the patient three times daily in each nostril for 45 days. Post treatment evaluation included symptom score improvement, clinical examination and post treatment histopathology. Results showed a significant reduction in patient's symptoms especially foul nasal discharge and crust formation. Post treatment histopathology results are also presented