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LARYNGEAL PAPILLOMATOSIS

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LARYNGEAL PAPILLOMATOSIS

Laryngeal papillomatosis is a rare medical condition that is characterized by the presence of wart-like growths (papilloma) that develops within the larynx on the vocal cords.

  • These growths are usually benign and primarily affects the vocal cords and glottis, however, any part of the respiratory tract, from the nose to the lungs can be affected.
  • It is also commonly known as recurrent respiratory papillomatosis.
  • It affects both adults and children. However, Juvenile laryngeal papillomatosis is more common and severe than the adult form of the disease.
  • The disease manifests most commonly in children under 5 and people between ages 30 and 40 and may rarely occur in people older than 60.
  • The juvenile form of the disease affects males and females in equal numbers, whereas in adults it is more common in males.
  • Recurrences of the condition are frequent and remission may occur after several years.
  • Annually, the number of new cases is around 4.3 cases per 100,000 children and 1.8 cases per 100,000 adults.

CAUSES

Laryngeal papillomatosis is caused by the human papillomavirus (HPV) types 6 and 11.  The disease is separated into adult and juvenile papillomatosis.

The juvenile form is caused by exposure to an infected mother’s vaginal canal during birth.

The risk factor for juvenile laryngeal papillomatosis includes being firstborn, having a mother younger than 20 and vaginal delivery.

The mode of transmission in adult is still unknown, but sexual transmission, especially through oral sex and multiple sexual partners has been implied as a potential mode of transmission.

SYMPTOMS

  • Change in voice quality
  • Hoarseness
  • A chronic cough
  • Shortness of breath. This can occur if the growth occurs in the airway, or when growth on the vocal cords are so much severe that they begin to block the airway.
  • Noisy breathing that mostly sounds like a snore
  • Pneumonia
  • Failure to thrive
  • Respiratory fatigue

DIAGNOSIS AND TREATMENT

Diagnosis is made through visualization of the growths using flexible fiberoptic laryngoscopy. This procedure is done by passing a flexible scope called fiberscope into the throat through the nose. This gives a clear picture of the larynx.

A biopsy can be obtained to confirm the diagnosis. This involves HPV testing of a sample of the growth.

TREATMENT

Treatment methods are aimed at removing and limiting the recurrence of papillomas.

Since the nature of the virus is recurrent, repeated treatment may be needed especially for children.

Voice therapy may be used to maintain the patient’s voice function.

But usually, the first line of treatment is surgery. Surgery is performed to remove papillomas.

The surgical procedure may include carbon dioxide laser surgery and microdebrider. These procedures are all carried out for the removal of papillomas.

However, microdebrider surgery is less costly, less time-consuming and more likely to give a better voice quality than the laser surgery approach.

Surgery may not be sufficient to treat laryngeal papillomatosis in some people, therefore additional medical treatments may be recommended.

These treatments only serve as a supplement to surgery as they are self-sufficient to cure laryngeal papillomas.

These supplemental treatments may include antiviral drugs such as cidofovir, interferon, and photodynamic therapy.