Papilloma


Description and Etiology

Laryngeal papilloma are caused by exposure to the human papilloma virus (HPV).

They can occur in both children and adults.  Some common sites for papillomatosis include the true vocal folds, trachea/bronchi, palate, nasal passages, and in rare instances the lungs.  The papillomas may recur very rapidly and can cause serious threat to the airway.  In severe cases treatment for laryngeal papilloma can require surgery every 2 to 4 weeks.  The functional impact on voice quality is highly substantial due to the frequent surgeries and subsequent vocal fold scarring.

 

Juvenile papillomatosis typically occurs within the first five years from perinatal infection. Children born to condylomatous mothers are at risk for developing juvenile onset papillomatosis yet juvenile papillomatosis is rare.

 

Adult laryngeal papillomatosis recurrence rate is slow rate compared with the fast rate at which juvenile papillomatosis recur.  Adult papillomatosis tend to be more localized within the upper airway.  The causative agents include sexual contact, trigger that reduces the autoimmune system and in rare cases severe gastroesophageal reflux. 

       Perceptual Signs and Symptoms

o      Rough quality of voice

o      Breathiness may occur if vocal fold closure effected

o      Potential difficulty breathing and noise on inhalation

o      Chronic cough

o      Weak cry

o      Periods of voice loss

       Features of Visual Assessment

o      Papilloma tends to interfere with vocal fold closure

o      “Wart or raspberry” type appearance

o      Adult cases usually appear as a solitary lesion

o      Juvenile cases tend to be spread throughout the airway

o      Increased stiffness on the vocal folds

o      Impedes vibratory characteristics of the vocal folds

o      Multiple surgical excisions:

§       Cover may be stiff

§       Interfere significantly with amplitude and vibratory behavior

 

       Management

o      Care for airway obstruction and ensure that ventilatory support is adequate

o      The surgical procedures only offer symptomatic relief

o      Microsurgical ablation

o      Microdebrider resection

o      Antiviral drugs

§       Indole-3-carbinol

§       Methotrexate

§       Cidofovir

o      Voice therapy during a state of nonrecurrence to reduce muscle tension and over compensation.