About laryngeal papilloma

What is laryngeal papilloma?

Laryngeal Papilloma is a rare medical condition in which non-cancerous tumors form along the aerodigestive tract. Laryngeal Papilloma grows inside the voice box, vocal cords, or the air passage from the nose to the lungs. The symptoms include breathing problems, difficulty swallowing, coughing, and hoarseness. Laryngeal Papilloma is a condition that has been researched in detail, but a cure is yet found.

The Condition

  • The condition is mostly seen in children before the age of three. Though it can be found in adults, too, the virus is believed to be spread through sexual contact though it has not yet been established.

  • Laryngeal Papillomatosis is caused by two types of Human Papillomavirus (HPV), namely HPV 6 or 11 viruses.

  • Laryngeal Papillomas are small, wart-like growths that can vary in size.

  • Although they are non-cancerous, less than 1 percent of them can become cancerous in some cases.

  • Currently, there is no cure for Laryngeal Papillomatosis; surgery is often recommended to remove tumors from the larynx or airway.

  • Laryngeal Papilloma can be stubborn; they often grow back easily, even after surgery.

  • Since the virus keeps recurring, repeated treatments are usually required.

  • The mode of transmission in juveniles is during normal vaginal childbirth, and the cause could be a mother's recently acquired genital warts.

  • Laryngeal Papillomatosis can affect anyone irrespective of age or gender. A vaccination before becoming sexually active is the most effective way to prevent the spread of the infection though it does not offer a hundred percent protection.

Symptoms    

  • Symptoms of laryngeal papillomatosis are hoarseness of voice, breathing difficulty, and chronic coughing.

Drugs

  • Currently, there is no cure for laryngeal papillomatosis; a laser surgery is often recommended to remove tumours from the larynx or airway.

  • The most successful drugs are interferon, acyclovir, valacyclovir, cidofovir and indole-3-carbinol. 

  • A vaccination before becoming sexually active is the most effective way to prevent the spread of the infection though it does not offer a hundred percent protection.



What are the symptoms for laryngeal papilloma?

Benign tumors that grow within the larynx, the voice box, are known as Laryngeal Papillomas. They are non-cancerous. They are also known as recurrent respiratory papillomatosis (RRP). The common symptoms of a Laryngeal Papilloma include:

  • Deepening of voice: As the tumor suppresses the vocal cords on either or both sides, it affects the quality of sound production. This causes abnormal vibration of the vocal cords, resulting in a hoarse and deep voice.

  • Swallowing difficulty: The oesophagus, also known as the food pipe, is present alongside the larynx. As the tumor suppresses the oesophagus, it causes difficulty in swallowing. In cases where the tumor is enlarged, it may also cause pain. This is also known as dysphagia. 

  • Difficulty in breathing: As the tumor puts pressure on the lungs and the trachea, it causes breathing difficulties. Patients often complain of the need to gasp for air, especially at night. In children, it is most commonly witnessed during their sleep time.

  • Coughing ( for a long period of time): Chronic Coughing is a common symptom of Laryngeal Papilloma. This is because the trachea is compromised due to the pressure of the tumor.

  • Ear pain: Pain in the ear is a referred pain associated with the Laryngeal Papilloma. This is because the eustachian tube or the ear canal is suppressed. Some patients may even feel a tingling sound, similar to ringing a bell.

  • Feeling of a knot in the throat: Patients with Laryngeal Papilloma often feel the presence of a knot or a lump in their throat.



What are the causes for laryngeal papilloma?

Laryngeal Papilloma is caused due to the Human Papillomavirus, known as the HPV. It is caused by two types of Human Papillomavirus (HPV): HPV 6 and HPV 11. 

  • The more aggressive forms of Papillomatosis, which may involve more distal parts of the tracheobronchial tree, are associated with HPV-11. 

  • The mode of viral inoculation varies according to the age of disease onset. It is not necessarily the presence of HPV in the respiratory tract that develops Laryngeal Papillomatosis. Immunodeficiency or similar infections can also be other factors that could be involved.

  • Depending on when the disease has been developed, before or after 20 years of age, it occurs in two forms, juvenile, and adult papillomatosis. It is transmitted through the mother's infected vaginal canal in the juvenile form. 

  • The transmission in adults is less known. As a potential mode of transmission, oral sex has been implicated, though. It is unclear if oral sex would directly transmit the virus or if the dormant virus transmitted at childbirth just gets activated.

  • There is no clear reason or explanation for why only a few people exposed to the human papillomavirus get Laryngeal Papilloma.

  • The juvenile form of the disease, developing Laryngeal Papillomatosis, is low in the child born from an infected mother, even if the mother's infection is active.



What are the treatments for laryngeal papilloma?

It might sound disheartening; however, there is no permanent treatment plan for the Laryngeal Papilloma. The tumor keeps coming back and needs to be treated again in most cases. The recurrent nature of the virus demands recurrent treatments, as seen in the case of the juvenile form of Laryngeal Papillomatosis, which relapses more aggressively than the adult form.

  • Surgical removal of the tumor: This is the most basic and commonly used treatment plan for Laryngeal Papilloma. An incision is made, and the tumor is excised. Endoscopy, the surgery protects the intact tissues and restores the individual's voice. It ensures that the disease does not obstruct the airway. Yet the recurrence cannot be prevented by the surgery. It can lead to several complications, which may be serious too.

  • Surgical removal of the trachea: In a few cases, the patient is advised to get the trachea removed surgically. 

  • Laser removal of the tumor: Laser surgery is commonly used these days. The most common laser surgery being used is with the help of carbon dioxide lasers. It has given a good prognosis to the patients and is a less invasive option. 

  • Tracheostomy: Tracheostomy is only indicated in patients where the tumor is causing a life-threatening condition. In this procedure, the patient is intubated, and breathing occurs via the intubation tube.



What are the risk factors for laryngeal papilloma?

Three major risk factors for a Laryngeal Papilloma

  • Birth history 

  • The genotype of the HPV (e.g., HPV-11)

  • Individual factors 

Other risk factors for a Laryngeal Papilloma include:

  • Alcohol: Heavy or moderate drinking increases the chances of Laryngeal Papilloma. The use of both tobacco and alcohol together increases the chance of getting the disease and multiplies it.

  • Human Papillomavirus infection: Papillomaviruses cause a type of growth called a Papilloma, also known as a wart.

  • Too much body weight: If your body weight is too much in respect to your height, it increases the chance of diseases. To reduce the risk, one should eat plant-based foods, like non-starchy vegetables and fruits.

  • Malnutrition: If you don't have a proper and balanced diet, it may lead to diseases. The cause is not clear, though.

  • Genetic syndromes: Inherited defective genes (mutations) have a very high risk of throat cancer, including hypopharynx cancer.

  • Workplace exposures: People who work for long hours and are often exposed to dust, chemical fumes, etc., and work in places like petrol stations, chemical industries, construction sites, metalworks, etc., are at high risk.

  • Age: They develop over many years and are less likely to be seen in young people.



Is there a cure/medications for laryngeal papilloma?

Though Laryngeal Papilloma is not really curable, the tumors and growths can be removed to prevent complications.

Drugs: Drug treatments may include antivirals. They help the body fight against diseases that are caused by certain viruses. They are also called preventive drugs. It helps us protect our body from catching a viral infection and spreading it to others.

  1. Antivirals used to treat laryngeal papilloma are interferon and cidofovir. 

  2. Interferon α and Cidofovir- These drugs block the virus from making copies of itself. They even help in lengthening the time between the surgical interventions.

  3. Indole-3-carbinol- It is formed from glucobrassicin, which is found in cruciferous vegetables such as broccoli, brussels sprouts, cabbage, collards, cauliflower, kale, mustard greens, turnips, and rutabagas. It is a cancer-fighting compound. 

  4. Bevacizumab is classified as a "monoclonal antibody" and "anti-angiogenesis" drug. It prevents the interaction of vascular endothelial growth factors and its receptor. Thus, influencing the growth of laryngeal papilloma.

Photodynamic therapy: To prevent recurrence of laryngeal papilloma in juveniles is the most difficult. The recurrence is due to the presence of mucosal cells infected by the papillomavirus. This cannot be detected with naked eyes. Photodynamic therapy (PDT) effectively helps in resolving this problem.



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