Laryngeal Papillomatosis - An Overview

Introduction

Laryngeal papillomatosis is a viral disease that can affect an individual's voice and breathing. This disease affects about 4.3 children and 1.8 adults out of every 10,000 individuals annually. Laryngeal papillomatosis can occur at any age but is commonly seen in children between two and four years of age and adults between 20 and 40 years of age. This article briefly explains laryngeal papillomatosis, including its cause, symptoms, diagnosis, and treatment.

What Is Laryngeal Papillomatosis?

Laryngeal papillomatosis is a non-cancerous, wart-like growth called papilloma that develops inside the respiratory tract. The respiratory tract is an organ system of the body that permits breathing. The nose, mouth, throat (pharynx), voicebox (larynx), windpipe, bronchi, and lungs are all parts of the respiratory tract. Although papilloma can occur anywhere in the respiratory tract, it most commonly affects the voice box (laryngeal papillomatosis). These tumors have the potential to spread to other respiratory tract organs. The condition is caused by the human papillomavirus (HPV). The papillomas are usually non cancerous. However, in rare cases, they may undergo cancerous transformation. Despite being benign, papillomas can result in serious respiratory issues and airway obstruction that could even be fatal.

When papillomas are removed, they often tend to grow back, multiply, and spread, which results in obstruction of the airways and is referred to as recurrent respiratory papillomatosis.

Based on the age at which the symptoms occur, laryngeal papillomatosis has two types:

• Juvenile-Onset Laryngeal Papillomatosis – This is an aggressive form of papillomatosis that causes symptoms before the age of 12. After treatment, there is a higher chance that the tumor will come back and spread. The child gets infected by their mother. The virus that causes this type of laryngeal papillomatosis is passed to the child during childbirth.

• Adult-Onset Laryngeal Papillomatosis – The symptoms of this type appear in adulthood. Compared to Juvenile on-set laryngeal papillomatosis, this is a less aggressive type and grows and separates more slowly.

What Causes Laryngeal Papillomatosis?

Laryngeal papillomatosis is caused by a virus called human papillomavirus.

Juvenile-Onset Laryngeal Papillomatosis – is thought to be transferred from mother to child after childbirth, particularly in cases where the mother has recently developed genital warts.

Adult-Onset Laryngeal Papillomatosis – This is thought to be spread through oral sex, although the exact mechanism is not fully understood.

What Are the Symptoms of Laryngeal Papillomatosis?

Most common symptoms include:

• Hoarseness of Voice - The voice of the affected individual may sound weak, raspy, low in pitch, or strained, and their hoarseness may get worse over time. The size and precise locations of papillomas can influence the severity of voice issues in different individuals.

• Stridor – Papilloma may obstruct the airway and cause labored, noisy breathing, which is called stridor. At initial, stridor only happens when breathing in, but eventually, it can happen while breathing in and breathing out.

• Dysphonia – Some individuals may experience difficulty in speaking.

• Aphonia – Some individuals may lose their voice completely.

• Weak cry.

• Episodes of choking.

• Fail to grow and gain weight.

Additional symptoms:

• Chronic cough.

• Difficulty swallowing (dysphagia).

• Shortness of breath or difficulty breathing (dyspnea).

• The sensation of a foreign body in the throat.

How Is Laryngeal Papillomatosis Diagnosed?

Diagnosis of laryngeal papillomatosis involves a multi-facet approach, including medical history, physical examination, and certain diagnostic tests.

• Medical History: A thorough medical history is taken by a doctor. The doctor will ask about previous incubations, history of symptoms, and any trauma or voice abnormality.

• Physical Examination: After the history taking is done, the doctor will look for any changes in the patient's stridor in different positions, such as tachypnea(rapid breathing), speech, and crying.

• Laryngoscopy: In this procedure, a thin flexible fiberoptic tube equipped with a camera–nasopharyngoscope is inserted to check the throat and vocal cords. Laryngeal papilloma appears as pink to white grape-like projections.

• Stroboscopy: It is an advanced procedure that is used along with narrow-band imaging (NBI) and can be extremely helpful in diagnosing laryngeal papillomatosis.

• Computed Tomography (CT) Scan: CT scan can be helpful in diagnosing papilloma In the lungs or any other respiratory lesions.

• Biopsy: This is the definitive test to diagnose laryngeal papillomatosis. It involves taking up a small sample of tissue, which is examined under a microscope to identify the specific type of HPV. Biopsy is important because laryngeal papilloma tends to transform into malignancy in up to 1 to 4 percent of cases.

What Is the Treatment of Laryngeal Papillomatosis?

Currently, there is no cure for laryngeal papillomatosis. The standard treatment involves surgical removal of papilloma and preserving the normal mucosa followed by advent therapy.

Surgery: Surgery is the standard treatment for papilloma. Many doctors now perform laser surgery since traditional surgery can result in complications because of tissue scarring in the larynx.

Microlaryngoscopy with laser removal is a preferred treatment for laryngeal papillomatosis.

Tumors can occur even after it has been removed. Patients frequently need more than one surgery.

Some patients may need surgery every few weeks, while others may need it once a year or even less frequently. In case of aggressive tumor growth tracheotomy (surgical hole in the trachea) is done to allow breathing.

Adjuvant Management: Adjuvant therapies may be used in addition to surgery when surgery alone is not enough. The criteria for the use of adjuvant therapy include four or more surgical procedures within a year, papilloma regrowth that occurs quickly, airway obstruction, and spread of disease.

The Adjuvant therapy options include the use of:

• Cidofovir – This medication is injected into the papilloma. It leads to toxicity against the virus.

• Interferon – Peginterferon alpha 2a Is the most widely used interferon however, it has been replaced by cidofovir because of its severe side effects.

• Indole-3 Carbinol – Cruciferous vegetables like broccoli and brussels sprouts contain indole-3-carbinol, a cancer-fighting substance, or Bevacizumab, which inhibits the formation of papilloma blood vessels.

What Are the Complications of Laryngeal Papillomatosis?

• Squamous Metaplasia – When doctors perform surgery, some healthy tissue may be accidentally damaged. This damage triggers the spread of the disease to nearby tissue.

• Vocal Cord Scarring or Glottic Webs – Aggressive removal of the tumor can damage vocal cords and can cause scarring and formation of bands of tissue on vocal cords, which results in hoarseness of voice and difficulty in speaking.

• Airway Fire – This is a particular risk associated with employing lasers in surgery. Lasers cut tissue by using very strong light. Airway fire can cause burns in the airway and surrounding tissues.

Conclusion

Laryngeal papillomatosis is a rare disease caused by HPV, typically affecting the larynx. The condition can cause voice and breathing issues. In order to avoid these issues and improve the quality of life of an individual early diagnosis and treatment are necessary. Modern medical technology and treatment approaches allow doctors to successfully manage this condition and help those who are affected by this illness.