User:Sara with no h/sandbox

I'm reviewing the article on Laryngeal papillomatosis, focusing primarily on the Treatment section of the article. I will also add a short Epidemiology section, no more than a paragraph or two. A collection of citations for myself --

Lead Working Draft

Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis or glottal papillomatosis, often associated with condyloma acuminata, is a rare medical condition caused by a human papillomavirus (HPV) infection of the throat. Laryngeal papillomatosis is caused by HPV types 6 and 11, in which benign tumors or papillomas form on the larynx or other areas of the respiratory tract [source]. If left untreated, these tumors/papillomas can obstruct the airway over time and be potentially fatal [source]. Treatment for laryngeal papillomatosis currently aims to remove and limit the recurrence of the papillomas, however due to the recurrent nature of the virus, repeated treatments usually are needed. Laryngeal papillomatosis is currently primarily treated surgically, however supplemental nonsurgical and/or medical treatments may be considered for some patients.The course of laryngeal papillomatosis is highly variable; however, while some patients do experience recovery, the condition is usually persistent. [source]

Epidemiology

Laryngeal papillomatosis shows a bimodal distribution, affecting primarily young children and young adults (generally between 20-40 years of age). The juvenile form of laryngeal papillomatosis generally is more aggressive than the adult form, often developing multiple papillomatous lesions compared to the adult form's solitary papillomas. The juvenile form also has a higher recurrence rate than the adult form.

Incidence of laryngeal papillomatosis has been estimated to be 4.0-4.3 per 100,000 in children and 1.8-2.0 per 100,000 in adults. Rates of laryngeal papillomatosis tend to be more elevated in groups of lower socioeconomic class and lower education level, however, no correlation has been found between severity of the disease and socioeconomic level. The incidence of the juvenile form of the disease has been reported to be elevated in children born of mothers with a history of genital warts (6.9 cases per 1000) relative to those born of mothers with no history of genital warts (0 cases per 1000); the former children also have been reported to be 231.4 times more at risk of developing laryngeal papillomatosis than the latter. The adult form of laryngeal papillomatosis tends to affect more men than women, however the prevalence of HPV in women has been on the rise, and currently is estimated to be roughly 45% in women aged 20-24 years.

Treatment

As no cure exists for laryngeal papillomatosis, current treatment options aim to remove and limit the recurrence of the papillomas. Repeated treatments are often needed because of the recurrent nature of the virus, especially for children, as the juvenile form of laryngeal papillomatosis often triggers more aggressive relapses than the adult form. Between recurrences, voice therapy may be used to restore or maintain the patient's voice function.

Surgery

Surgery is the current treatment of choice, and can help remove papillomas and protect uninvolved tissue; that being said, surgery does not prevent recurrences, and can lead to a number of serious complications. Laser technology, and carbon dioxide laser surgery in particular, has been used since the 1970s for the removal of papillomatosis; however, laser surgery is not without its risks, and has been associated with a higher occurrence of respiratory tract burns, stenosis, severe laryngeal scarring, and tracheoesophagyeal fistulae. Tracheotomies are offered for the most aggressive cases, where multiple debulking surgery failures have led to airways being compromised. The tracheotomies use breathing tubes to reroute air around the affected area, thereby restoring the patient's breathing function. Although this intervention is usually temporary, some patients must use the tube indefinitely. This method should be avoided if at all possible, since the breathing tube may serve as a conduit for spread of the disease as far down as the tracheobronchal tree.

A microdebrider is a tool that can suction tissue into a blade, which then cuts the tissue. Microdebriders are gradually replacing laser technology as the treatment of choice for laryngeal papillomatosis, due to their ability to selectively suction papillomas while relatively sparing unaffected tissue. In addition to the the lower risk of complications, microdebrider surgery also is reportedly less expensive, less time-consuming, and more likely to give the patient a better voice quality than the traditional laser surgery approaches.

Nonsurgical adjuvant treatment

For about 20% of patients, surgery is not sufficient to control their laryngeal papillomatosis, and additional nonsurgical and/or medical treatments are necessary. At the present time, these treatments alone are not sufficient to cure laryngeal papillomatosis, and can only be considered supplemental to surgery. Some varieties of nonsurgical treatments include interferon, antiviral drugs (especially Cidofovir, but also Ribavirin and Acyclovir), and photodynamic therapy. The potential of some nonsurgical treatments, in particular the measles-mumps-rubella vaccine, to reduce rate of recurrences has been investigated, but has not yielded significant results so far.

Traditional surgery 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 tumors by using targeted dyes and bright light to illuminate tumors. In this procedure, a physician injects a light-sensitive dye that is only absorbed by the tumors. Then the physician 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.

Many antiviral drugs 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. Adjuvant chemotherapy with interferon may be used in very severe cases. Regardless of the treatment used, the tumors will recur. In severe cases, tumors may occur once or twice a month. In less severe cases, tumors may occur once or twice a year. In addition, speech therapy may be beneficial to assist with vocal hygiene and retraining of voice.