Patient Education - Laryngeal Papillomas

Laryngeal papillomatosis is a disease consisting of tumors that grow inside the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract). It is a rare disease caused by the human papilloma virus (HPV). Although scientists are uncertain how people are infected with HPV, they have identified more than 60 types of HPVs. Tumors caused by HPVs, called papillomas, are often associated with two specific types of the virus (HPV 6 and HPV 11). They may vary in size and grow very quickly. Eventually, these tumors may block the airway passage and cause difficulty breathing.

Laryngeal papillomatosis affects infants and small children as well as adults. Between 60 and 80 percent of cases occur in children, usually before the age of three. Because the tumors grow quickly, young children with the disease may find it difficult to breathe when sleeping, or they may experience difficulty swallowing. Adults with laryngeal papillomatosis may experience hoarseness, chronic coughing, or breathing problems.

There are several tests to diagnose laryngeal papillomatosis. Two routine tests are indirect and direct laryngoscopy. An indirect laryngoscopy is done in an office by a speech-language pathologist or by a doctor. To examine the larynx for tumors, the doctor places a small mirror in the back of the throat and angles the mirror down towards the larynx. A direct laryngoscopy is performed in the operating room under general anesthesia.

This procedure is usually used with children or adults during lengthy examinations to minimize discomfort. It involves looking directly at the larynx. Direct laryngoscopy allows the doctor to view the vocal folds and other parts of the larynx under high magnification and samples of unusual tissue lesions that may be in the larynx or other parts of the throat.

Treatment

Many forms of treatment have been used to remove laryngeal papillomas such as surgery, chemotherapy, or antibiotic therapy. Currently, traditional surgical removal of the tumors and another technique, carbon dioxide laser surgery, are both used. Carbon dioxide laser surgery uses intense laser light as the surgical tool.

Once they have been removed, these tumors have a tendency to return unpredictably. It is not uncommon for patients to require repeat surgery. With some patients, surgery may be required every few weeks in order to keep the breathing passage open, while others may require surgery only once a year. In the most extreme cases where tumor growth is aggressive, a tracheotomy may be performed. A tracheotomy is a surgical procedure where an incision is made in the front of the patient's neck and a breathing tube (trach tube) is inserted through a hole, called a stoma, into the trachea (windpipe). Rather than breathing through the nose and mouth, the patient will now breathe through the trach tube. Although the trach tube keeps the breathing passage open, doctors try to remove it as soon as it is feasible. However, there may be some patients who may be required to keep a trach tube indefinitely in order to keep the breathing passage open. In addition, because the trach tube re-routes all or some of the exhaled air away from the vocal cords, the patient may find it difficult to speak. With the help of a voice specialist or speech-language pathologist the patient learns how to reuse the voice.

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