Laryngeal papillomatosis
Encyclopedia
Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis or glottal papillomatosis, is a rare medical condition
(2 per 100,000 adults and 4.5 per 100,000 children), caused by a HPV
infection of the throat. Laryngeal papillomatosis causes assorted tumor
s or papilloma
s to develop over a period of time. Without treatment it is potentially fatal as uncontrolled growths could obstruct the airway
. Laryngeal papillomatosis is caused by HPV types 6 and 11, in which benign tumors form on the larynx or other areas of the respiratory tract. These tumors can reoccur frequently, may require repetitive surgery, and may interfere with breathing. The disease can be treated with surgery and antivirals.
.
, which can sound like a whistle or a snore, and is a sign that the laryngeal or tracheal parts of the airway are narrowing.
The most accurate way to diagnose laryngeal papillomatosis is for a biopsy
to be conducted and for the lesion to be tested for HPV. This procedure takes place in an operating room with the patient under general anesthesia. This is sometimes the best option for small children. This disease is most often misdiagnosed as asthma
, croup
, or chronic bronchitis
. The consequences may be serious, as papillomas are at least partially obstructing the airway to cause these symptoms and should be removed immediately.
and carbon dioxide laser
surgery, a "no touch" removal of affected tissue, are forms of treatment for laryngeal papillomatosis. Carbon dioxide laser removal is the most common removal method. The carbon dioxide laser must be used precisely to prevent scarring, fibrosis
, and laryngeal web malformation. In children, carbon dioxide laser is effective for removing papillomas on the larynx.
Photodynamic therapy
controls tumor
s by using targeted dyes and bright light to illuminate tumors. In this procedure, a doctor injects a light sensitive dye that is only absorbed by the tumors. Then the doctor activates the dye using a bright light, and the tumors are eliminated. This procedure has also been able to decrease the number of tumors that reoccur .
Another method is tracheotomy
, which reroutes air around the affected area. An incision is made in the front of the patient's neck, and a breathing tube
is inserted through a hole (stoma) into the windpipe. The patient is then able to breathe through the tube. Although this is usually temporary, some patients must use the tube indefinitely . This method should be avoided if at all possible, since insertion of a breathing tube may cause the tumors to form as far down as the lungs.
Many Antiviral drug
s like Cidofovir have been used to treat laryngeal papillomatosis, but none completely stops the tumors from growing. Most antivirals are injected to control the frequency of tumor growth. The efficacy of the same is debated and subject to research. Some side effects of antivirals include dizziness, headaches, and body aches.
Regardless of the treatment used, the tumors will reoccur. In severe cases, tumors may occur once or twice a month. In less severe cases, tumors may occur once or twice a year.
Rare disease
A rare disease, also referred to as an orphan disease, is any disease that affects a small percentage of the population.Most rare diseases are genetic, and thus are present throughout the person's entire life, even if symptoms do not immediately appear...
(2 per 100,000 adults and 4.5 per 100,000 children), caused by a HPV
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
infection of the throat. Laryngeal papillomatosis causes assorted tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s or papilloma
Papilloma
Papilloma refers to a benign epithelial tumor growing exophytically in finger-like fronds. In this context papilla refers to the projection created by the tumor, not a tumor on an already existing papilla . When used without context, it frequently refers to infections caused by human...
s to develop over a period of time. Without treatment it is potentially fatal as uncontrolled growths could obstruct the airway
Airway
The pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...
. Laryngeal papillomatosis is caused by HPV types 6 and 11, in which benign tumors form on the larynx or other areas of the respiratory tract. These tumors can reoccur frequently, may require repetitive surgery, and may interfere with breathing. The disease can be treated with surgery and antivirals.
Transmission
In general, doctors are not sure what causes some people to contract laryngeal papillomatosis while others who have been exposed to HPV types 6 and 11 do not contract the disease. Since the disease is most commonly found in children the disease may be caused by an infant contracting HPV from the mother during vaginal child birth . There is no evidence that it is transmitted through oral sex, and it is not considered a sexually transmitted diseaseSexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
.
Adults
In adults the symptoms Laryngeal papillomatosis are hoarseness, or a strained or breathy voice. Size and placement of the tumors dictate the change in the person's voice. Breathing difficulties may occur but more commonly are found in children.Children
In babies and small children the symptoms include a weak cry, trouble swallowing, noisy breathing, and chronic cough. Noisy breathing may be a stridorStridor
Stridor is a high pitched wheezing sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is produced by narrow or obstructed airway path. It can be inspiratory, expiratory or biphasic . Inspiratory stridor is common...
, which can sound like a whistle or a snore, and is a sign that the laryngeal or tracheal parts of the airway are narrowing.
Diagnosis
A doctor may diagnose laryngeal papillomatosis by placing a mirror into a patient's mouth to reflect light onto the vocal cords and examining the larynx. More often, a doctor or a trained speech-language pathologist diagnoses laryngeal papillomatosis by an indirect laryngoscopy in the office. This procedure involves the placement of a flexible, fiber optic camera through the patient's nose to view the vocal folds in the throat or the use of a straight, rigid camera placed through the mouth to view the vocal folds.The most accurate way to diagnose laryngeal papillomatosis is for a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
to be conducted and for the lesion to be tested for HPV. This procedure takes place in an operating room with the patient under general anesthesia. This is sometimes the best option for small children. This disease is most often misdiagnosed as asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, croup
Croup
Croup is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness...
, or chronic bronchitis
Chronic bronchitis
Chronic bronchitis is a chronic inflammation of the bronchi in the lungs. It is generally considered one of the two forms of chronic obstructive pulmonary disease...
. The consequences may be serious, as papillomas are at least partially obstructing the airway to cause these symptoms and should be removed immediately.
Treatment
Traditional surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
and carbon dioxide laser
Carbon dioxide laser
The carbon dioxide laser was one of the earliest gas lasers to be developed , and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available...
surgery, a "no touch" removal of affected tissue, are forms of treatment for laryngeal papillomatosis. Carbon dioxide laser removal is the most common removal method. The carbon dioxide laser must be used precisely to prevent scarring, fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
, and laryngeal web malformation. In children, carbon dioxide laser is effective for removing papillomas on the larynx.
Photodynamic therapy
Photodynamic therapy
Photodynamic therapy is used clinically to treat a wide range of medical conditions, including malignant cancers, and is recognised as a treatment strategy which is both minimally invasive and minimally toxic...
controls tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s by using targeted dyes and bright light to illuminate tumors. In this procedure, a doctor injects a light sensitive dye that is only absorbed by the tumors. Then the doctor activates the dye using a bright light, and the tumors are eliminated. This procedure has also been able to decrease the number of tumors that reoccur .
Another method is tracheotomy
Tracheotomy
Among the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
, which reroutes air around the affected area. An incision is made in the front of the patient's neck, and a breathing tube
Tracheal tube
A tracheal tube is a catheter that is inserted into the trachea in order for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes are available, suited for different specific...
is inserted through a hole (stoma) into the windpipe. The patient is then able to breathe through the tube. Although this is usually temporary, some patients must use the tube indefinitely . This method should be avoided if at all possible, since insertion of a breathing tube may cause the tumors to form as far down as the lungs.
Many Antiviral drug
Antiviral drug
Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics for bacteria, specific antivirals are used for specific viruses...
s like Cidofovir have been used to treat laryngeal papillomatosis, but none completely stops the tumors from growing. Most antivirals are injected to control the frequency of tumor growth. The efficacy of the same is debated and subject to research. Some side effects of antivirals include dizziness, headaches, and body aches.
Regardless of the treatment used, the tumors will reoccur. In severe cases, tumors may occur once or twice a month. In less severe cases, tumors may occur once or twice a year.