What Is Recurrent Respiratory Papillomatosis?
Recurrent respiratory papillomatosis is a condition affecting the air passage characterized by small non-cancerous tumors called papillomas. The growth can occur anywhere along the air passage leading from the nose and mouth to the lungs, but the most common site of occurrence is the larynx (voice box).
Even after the growth is removed, there is a high chance that the growth will recur because the virus still persists in the tissue. The location of the growth decides what all symptoms the patient will have. Growth on the vocal cord can result in voice change, and if the lesion is big enough to block the air passage, then it can cause breathing problems too.
What Causes Recurrent Respiratory Papillomatosis?
Recurrent respiratory papillomatosis is caused by a virus called the Human Papillomavirus (HPV). There are about 150 types of HPV, among which HPV 6 and HPV 11 cause this condition. People who get affected by HPV never have a related illness. However, a small group of people who encountered HPV 6 and HPV 11 developed genital warts and respiratory papillomas. This virus usually spreads to other people through sexual contact or from a mother with a genital wart who passes the HPV 6 or HPV 11 virus to the child during childbirth.
Who Is Affected by Recurrent Respiratory Papillomatosis?
There are adult-onset recurrent respiratory papillomatosis and juvenile-onset recurrent respiratory papillomatosis. The adult-onset is the one which is seen in the adults. At the same time, the juvenile is the recurrent respiratory papillomatosis which is seen in infants and small children.
What Are the Symptoms of Recurrent Respiratory Papillomatosis?
The symptoms of recurrent respiratory papillomatosis are:
-
Hoarseness- Hoarseness is the most common symptom of recurrent respiratory papillomatosis. The papillomas on the vocal cord interfere with their vibrations.
-
Difficulty in Breathing- When these papillomas grow in size, they can interfere with the passage of air through them, and hence the patient will have breathing difficulty. Breathing difficulty is more prevalent in children, especially while the child is sleeping, because the growth rate of the tumor is faster than in adults.
-
Difficulty in Swallowing- As these papillomas can interfere with the swallowing of food, and this symptom is also mainly seen in children.
-
Chronic Coughing- These growths can cause irritation in the larynx, and the patient may have coughing.
How Is Recurrent Respiratory Papillomatosis Diagnosed?
Recurrent respiratory papillomatosis is diagnosed by the specialist using two routine tests, they are:
-
Indirect Laryngoscopy- An otolaryngologist (a doctor who specializes in diseases of the nose, ear, and throat) or speech-language pathologist inserts a fiber-optic tube called an endoscope through the nose or mouth, and the passage and the larynx are viewed on-screen. Sometimes a video camera may be attached to it; then, it can also be viewed as well as recorded.
-
Direct Laryngoscopy- This procedure is done under general anesthesia in the operating room. This procedure is done to view the vocal folds and other parts of the larynx under higher magnification. This procedure is done especially for children to minimize discomfort and also to take tissue samples from the larynx or other parts of the throat to obtain a diagnosis.
How Is Recurrent Respiratory Papillomatosis Treated?
The recurrent respiratory papillomatosis once develops; there is no permanent cure for this condition.
-
The treatment available for this condition is surgically removing the growth from the larynx. The surgeries help to treat the symptoms of the condition and treat the disease itself. Surgeries help to reduce the size or remove the tumor and do not treat the underlying cause of the disease, which is a viral infection. Apart from the traditional surgical techniques, doctors now prefer laser surgery as the other technique leaves scarring on the larynx tissue. Among lasers, carbon dioxide or potassium titanyl phosphate lasers are frequently used.
-
The other device, called a microdebrider, is used in which the suction is used to hold the tumor in place, and a small internal rotary blade is used to remove the growth.
-
In extremely aggressive cases of tumor growth, tracheostomy might be needed. In tracheostomy, an incision is made in the front of the patient’s neck, and a breathing tube is inserted through an opening, called stroma into the windpipe. When the tube is inserted, instead of breathing through the nose and mouth, the patient will now breathe through the trach tube. The doctors prefer to remove the tube when the need is not there. But in some cases, prolonged intubation might be needed to keep the breathing passage open. With the tube in place, the patient will find it difficult to use his or her voice. In such cases, with the help of a voice specialist or speech-language pathologist, the patient learns to use his or her voice with the use of a speaking valve.
-
In severe cases of recurrent respiratory papillomatosis, certain other therapies are needed, along with surgery. Treatment with drugs like antivirals will block the virus from copies of itself, and cancer-fighting compounds found in vegetables such as broccoli and brussel sprouts target the growth of papillomas in the blood vessel.
Recurrent respiratory papillomatosis is a disease with a high recurrence rate, and hence it is important to undergo routine examination and, if necessary, undergo multiple surgeries to limit the effects of recurrent respiratory papillomatosis on the voice box.
How Is Recurrent Respiratory Papillomatosis Prevented?
The infection is caused due to a virus called the Human Papillomavirus. There is a vaccination available with the HPV vaccine, which can prevent the development of recurrent respiratory papillomatosis. This vaccination is recommended for both boys and girls of age 11 and 12 years.
Conclusion
Recurrent respiratory papillomatosis is a condition affecting the windpipe, but the most common site of occurrence is the voice box. The condition can affect the respiratory passage and can cause symptoms related to it. If you have any trouble related to voice or breathing, consider consulting a doctor as the doctors can get to a diagnosis early, and if at all treatment is needed, it can be started. This condition is seen as mainly affecting and can affect the quality of their life. Vaccines can prevent this condition to some extent, so always vaccinate your child at their turn.
