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Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis, is a rare medical condition(2 per 100,000 adults and 4.5 per 100,000 children)[1]: 411 , caused by a HPV infection of the throat.[2]: 411 Laryngeal papillomatosis causes assorted tumors or papillomas to develop over a period of time. Without treatment it is potentially fatal as uncontrolled growths could obstruct the airway.Laryngeal papillomatosis is caused by HPV types 6 and 11, in which benign tumors form on the larynx or other areas of the respiratory tract.These tumors can reoccur frequently, may require repetitive surgery, and may interfere with breathing. Transmission of the disease is believed to be due to vaginal birth, oro-anal contact, or oro-genital contact. The disease can be treated with surgery and antivirals.
Transmission
[edit]In general, doctors are not sure what causes some people to contract laryngeal papillomatosis while others who have been exposed to HPV types 6 and 11 do not contract the disease. Since the disease is most commonly found in children the disease may be caused by an infant contracting HPV from the mother during vaginal child birth [3]: 411 . As for adults who contract the disease, it is likely that an adult contracted laryngeal papillomatosis by having oro-anal or oro-genital contact. Although laryngeal papillomatosis is not considered a sexually transmitted disease, it is more likely that adult onset of laryngeal papillomatosis is due to intercourse than a latent disease from childhood [4].
Symtoms
[edit]Adults
[edit]In adults the symptoms Laryngeal papillomatosis are hoarseness, strained, a breathy voice. Size and placement of the tumors dictates the change in the person's voice. Breathing difficulties may occur, but is more commonly found in children. [3]
Children
[edit]In babies and small children the symptoms include, a weak cry, trouble swallowing, noisy breathing, and chronic cough. Noisy breathing may be a stridor which can sound like a whistle or a snore and is a sign that the laryngeal or tracheal parts of the airway are narrowing. [3]
Diagnosis
[edit]A doctor may diagnosis laryngeal papillomatosis by placing a mirror into a patient's mouth to reflect light onto the vocal cords and examine the larynx. More often a doctor or a trained speech-language pathologist diagnoses laryngeal papillomatosis byan indirect laryngoscopy in the office.
This procedure involves the placement of a flexible fiber optic camera through the patients nose to view the vocal folds in the throat or the use of a straight, rigid camera placed through the mouth that shines down the throat onto the vocal folds.[5]
The most accurate way to diagnos laryngeal papillomatosis is for a biopsy to be conducted and the lesion tested for HPV. This procedure takes place in an operating room with the patient under general anesthesia. This is sometimes the best option for small children. This disease is most often misdiagnosed as asthma, croupe, or chronic bronchitis.[4] The consequences may be serious as papillomas are at least partially obstructing the airway to cause these symptoms and should be removed immediately [5].
Treatment
[edit]Traditional surgery andCarbon 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[4].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[1]. In this procedure a doctor injects a light sensitive dye that is only absorbed by the tumors. Then the doctor activates the dye using a bright light and the tumors are eliminated. This procedure has also been able to decrease the amount of tumors that reoccur [1]. Another method is tracheotomy, which reroutes air around the affected area. An incision is made in the front of the patient's neck and a breathing tube is inserted through a hole (stoma) into the windpipe. The patient is then able to breathe through the tube. Although this is usually temporary some patients must keep the tube indefinitely [1]. This method should be avoided if at all possible, since insertion of a breathing tube may cause the tumors to form as far down as the lungs[4]. Many antivirals have been used to treat laryngeal papillomatosis, but none completely stop the tumors from growing. Most of the antivirals are injected and can control the frequency of the tumor growth. Some of the antiviral's side effects include dizziness, headaches, and body aches. Regardless of the treatment used the tumors will reoccur. In severe cases, tumors may occur once or twice a month and in less severe cases tumors may occur once or twice a year.
References
[edit]- ^ a b c d ">"National Institute of Deafness and other Communication Disorders". http://www.nidcd.nih.gov/health/voice/laryngeal.asp.
{{cite web}}: External link in|location=|url=(help) - ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
{{cite book}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ a b c ">"VoiceProblems.org". http://www.voiceproblem.org/disorders/rrp/symptoms.asp.
{{cite web}}: External link in|location=|url=(help) - ^ a b c d ">McClay MD,John E (10/29/08). "Recurrent Respiratory Papillomatosis". http://www.voiceproblem.org/disorders/rrp/symptoms.asp.
{{cite web}}: External link in|location=|url=(help)CS1 maint: numeric names: authors list (link) - ^ a b ">"Recurrent Respiraory Papillomatosis Foundation". http://www.nidcd.nih.gov/health/voice/laryngeal.asp.
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