Laryngeal Papillomatosis: Causes, Symptoms, Treatment, Diagnosis
What is Laryngeal Papillomatosis?
Laryngeal Papillomatosis which is also known by the name of Recurrent Respiratory Papillomatosis is a pathological condition involving the respiratory tract in which there is growth of tumors in the air passages from the nose and mouth into the lungs. Even though these tumors may develop anywhere in the respiratory tract, they are mostly found in the larynx or the voice box and hence they are called as Laryngeal Papillomatosis. The size of these tumors is variable but they tend to grow very rapidly.
The main symptom of Laryngeal Papillomatosis is hoarseness of voice and difficulty swallowing and breathing. This condition is more seen in children than in adults. The front line treatment for Laryngeal Papillomatosis is surgical removal of the tumors but these tumors have a tendency to come back even after surgical removal and hence periodic followups is essential for people with Laryngeal Papillomatosis even after surgical removal of the tumors.
What are the Causes of Laryngeal Papillomatosis?
The root cause for development of Laryngeal Papillomatosis is the HPV or Human Papilloma Virus. This virus is normally transmitted to an adult through unprotected sex and to a child from an infected mother when the child is being delivered through the birth canal. The main subtype of HPV responsible for Laryngeal Papillomatosis is HPV 6 and HPV 11. People infected with this virus tend to develop small wart like tumors called papillomas which further progresses to cause Laryngeal Papillomatosis.
What are the Symptoms of Laryngeal Papillomatosis?
Hoarseness of voice is the first presenting symptom of Laryngeal Papillomatosis. The voice that comes out from us is produced when air from the lungs is pushed past two elastic muscles called the vocal cords. Due to Laryngeal Papillomatosis, the normal passage of air through these vocal cords is compromised and hence the individual tends to have a hoarse voice. As the disease progresses there may be complete blockage of the nasal airway causing breathing difficulties which is yet another symptom of Laryngeal Papillomatosis. Since these tumors grow very rapidly, children especially may find it very hard to breathe even while sleeping and may even find it difficult to swallow foods. Apart from these symptoms, individuals may also experience chronic coughing along with breathing problems and hoarseness of voice as a symptom of Laryngeal Papillomatosis.
How is Laryngeal Papillomatosis Diagnosed?
The test to confirm the presence of Laryngeal Papillomatosis is laryngoscopy. This can be done in two ways which are direct or indirect. In an indirect laryngoscopy, the ENT physician will insert a flexible endoscope fitted with a minature camera into the mouth and take a close look at the larynx through the monitor to see the presence of any tumor. A direct laryngoscopy is done in the operating room under general anesthesia. This method allows the ENT physician to take a look at the larynx under high magnification and gives a much clearer picture of the area and confirms the diagnosis of Laryngeal Papillomatosis.
How is Laryngeal Papillomatosis Treated?
As of now, there is no clear cut treatment for Laryngeal Papillomatosis. Surgery is the only way to remove the tumors from the air passage so that air can flow freely through the passage and breathing becomes easier and also the quality of the voice improves. The main risk with surgery is that surgical removal may leave a lot of scarring of the larynx tissue.
The more novel method of removing tumors from the larynx is by use of laser technique. In this procedure, carbon dioxide lasers are used to destroy the tumors. Another way to get rid of Laryngeal Papillomatosis is the use of micro-debrider, which uses suction to hold the tumor and a small internal rotary blade is used to remove the tumor.
The problem with Laryngeal Papillomatosis is that these tumors have a high tendency to recur and hence the patient may need to have repeat surgery. In some cases, surgery may be required every few weeks to get rid of Laryngeal Papillomatosis and allow the patient to breath normally while some patients may need surgery probably once a year.
In extreme cases, a tracheostomy may need to be performed to get rid of Laryngeal Papillomatosis but this is done only when the growth* of the tumor is extremely aggressive and rapid. In this procedure, an incision is made in the front of the patient's neck and a breathing tube is inserted through an opening into the trachea and rather than breathing through the nose and mouth patient breathes through this tube. This method normalizes the breathing but physicians prefer to keep this as a temporary measure and try to remove the tube as early as possible but some patients in extreme cases may need to have this tube put on indefinitely to breathe normally and moreover with the use of a trach tube the patient may find it difficult to speak as the air does not pass the vocal cords due to the tube and hence the patient may require speech therapy to learn how to speak postsurgery for Laryngeal Papillomatosis.