What is Laryngeal Papillomatosis?
Laryngeal papillomatosis is rare respiratory disease in which growths along the passages from the mouth and nose to the lungs develop and obstruct airflow. The condition is also known as recurrent respiratory papillomatosis or glottal papillomatosis and is quite rare.
The condition is characterized by the appearance of papillomas or tumors along the respiratory tract, but primarily in the larynx. The appearance of such papillomas in the larynx is most problematic, and untreated and uncontrolled growths can pose a serious threat to life. The tumors that form are mostly benign and can be removed surgically, but they often return after removal.
Laryngeal papillomatosis and the resultant laryngeal tumors are caused by two kinds of human papilloma virus, better known as the HPV virus. In most cases, people who are exposed to HPV do not experience any kind of illness, but there are over 150 different types of HPV, many that cause different kinds of illnesses with different symptoms. Many of them cause warts and tumors that are generally benign. They are also associated with cervical cancer in females.
In the case of laryngeal papillomatosis, the infection is caused by the HPV 6 and HPV 11 viruses, which also commonly cause genital warts. There is still uncertainty about how the infection occurs and why it causes illness in some individuals. One source of infection that is established is that the infection can be passed on to a baby during natural childbirth. In adults, it has not yet been established if laryngeal papillomatosis is a sexually transmitted disease.
Laryngeal papillomatosis can affect anyone irrespective of age or gender. Adults may be affected with the infection and it can also affect infants and children when they contract the virus at birth.
In a healthy human being, sound or speech is produced by the movement of air past the vocal cords with adequate pressure. This air is pushed through the passage from the lungs, but the pressure is greatly reduced when there are tumors in the region. Laryngeal tumors affect the way in which the vocal folds vibrate, causing symptoms like hoarseness. This is in fact the most common symptom of laryngeal papillomatosis, but the tumors and growths if unchecked can cause further blockage, restricting the flow of air to the lungs and causing severe breathing difficulties.
Typical symptoms of laryngeal papillomatosis therefore include:
- Hoarseness of voice
- Breathing difficulty
- Chronic coughing
These symptoms are usually a lot more severe in children and because of the rapid growth of tumors. Children are also prone to suffering greater breathing difficulty when sleeping and they may also show signs of appetite loss because of difficulty swallowing. Fortunately for some children, these symptoms start to recede once they reach puberty.
In some cases doctors may be able to make a diagnosis of laryngeal papillomatosis by simply using a mirror positioned in the patient’s mouth in a way that it reflects light on the vocal folds and the larynx. The most commonly used method of diagnosis, however, is an indirect laryngoscopy. To perform this procedure a flexible fiber optic camera is inserted through the patient’s nose and it gives the physician a clear view of the vocal folds. Alternatively, the physician may also use a straight, rigid camera, which would instead need to be positioned through the mouth.
A direct larygoscopy may also be used for the diagnosis. A biopsy can also be obtained during the procedure and the lesion can be tested for HPV. This method of diagnosis is often recommended for children because of the minimum discomfort of the procedure due to the general anesthesia and high risk of complications that could result from a misdiagnosis.
Laryngeal papillomatosis is not really curable, but the tumors and growths can be removed to eliminate the symptoms and prevent complications. Antiviral drugs may be prescribed but surgical treatment is the primary treatment. Conventional surgery is rapidly being replaced by laser surgery, as this minimizes the risk of scarring of the larynx tissue, which sometimes occurred in conventional surgery. Carbon dioxide lasers are currently the most widely used surgical device for this practice. Another surgical tool that has become instrumental in the tumor removal procedure is the microdebrider. This device holds the tumor in place using suction, while the growth is removed by an internal rotary blade.
Unfortunately, even after removal these tumors have a tendency to recur and patients often need to undergo surgery yet again. The situation can be so bad in some cases that patients need to undergo surgery just to be able to keep breathing, as the passages start to get obstructed. In other cases, the surgical procedure may need to be repeated just once in the year. In severe cases, where the tumor growth is just too aggressive to be dealt with surgically, doctors may recommend a tracheotomy. As a result of this procedure the patient can now breathe without the use of the nose and mouth, instead relying on the trach tube. Although this keeps the breathing passage open, it is best that the trach tube be removed at the earliest. There are, however, cases where the tube has to be left indefinitely to ensure the breathing passage stays open.
In cases where patients undergo a tracheotomy, they will also need the help of speech and language therapists in order to learn to get control and adjust to vocal changes that are likely to occur because of the redirection of some of the exhaled air via the trach tube.
Health Tips for HPV Infections
Sexually transmitted HPV infections are extremely rare in adults who are not sexually active, which means that taking adequate precautions is absolutely necessary. Vaccination before becoming sexually active is the most effective way to prevent the spread of the infection. HPV vaccination can help to prevent a new HPV infection but it cannot help in anyway if the individual is already infected with the virus. Keep in mind that although HPV vaccines can help to prevent infection with some types of HPV they do not offer protection against all types of HPV infection. Having safe sex by using condoms is actually an effective method of protection but it does not provide complete protection as any exposed areas are still vulnerable to infection.
- Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis - (http://www.nidcd.nih.gov/health/voice/pages/laryngeal.aspx)
- Laryngeal papillomatosis - (https://en.wikipedia.org/wiki/Laryngeal_papillomatosis)
- What is Recurrent Respiraory Papillomatosis? - (http://www.rrpf.org/whatisRRP.html)
- Human Papillomavirus (HPV) Vaccines - (http://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet#r15)
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Shaun DMello. 2021. Laryngeal Papillomatosis - Causes, Symptoms, Diagnosis, Treatment, Health Tips. Medindia, viewed Dec 08, 2023, https://www.medindia.net/patients/patientinfo/laryngeal-papillomatosis.htm.
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