What Causes Laryngeal Papillomatosis?

Reviewed on 6/11/2021

Laryngeal papillomatosis is a rare disease that causes benign (noncancerous) tumors called papillomas grow inside the voice box (larynx), vocal cords, or the air passage from the nose to the lungs (respiratory tract). It is caused by two types of human papillomavirus (HPV), HPV 6 and HPV 11, and is spread from person to person sexually or from mother to baby during childbirth.
Laryngeal papillomatosis is a rare disease that causes benign (noncancerous) tumors called papillomas grow inside the voice box (larynx), vocal cords, or the air passage from the nose to the lungs (respiratory tract). It is caused by two types of human papillomavirus (HPV), HPV 6 and HPV 11, and is spread from person to person sexually or from mother to baby during childbirth.

Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis (RRP), is a rare disease in which benign (noncancerous) tumors called papillomas grow inside the voice box (larynx), vocal cords, or the air passage from the nose to the lungs (respiratory tract). 

Most laryngeal papillomas (tumors) develop in children before the age of three. 

Laryngeal papillomatosis is caused by two types of human papillomavirus (HPV):

  • HPV 6 and
  • HPV 11.

HPV does not cause illness in most people, but a small number of people exposed to the HPV 6 or 11 virus can develop respiratory tract papillomas and genital warts

It is not known why some people develop the disease and others do not, but the virus is believed to be spread through sexual contact or when a mother with genital warts passes the HPV 6 or 11 virus to her baby during childbirth. 

What Are Symptoms of Laryngeal Papillomatosis?

Laryngeal papillomas (tumors) are usually quick growing and can vary in size and can cause symptoms including: 

Laryngeal papillomas may be misdiagnosed as asthma or chronic bronchitis because many of the symptoms are similar. 

How Is Laryngeal Papillomatosis Diagnosed?

Laryngeal papillomatosis is diagnosed with a patient history and a physical examination, and 

two main tests: 

  • Indirect laryngoscopy 
    • A fiber optic telescope (endoscope) is inserted into the nose or mouth and the larynx is viewed on a monitor
  • Direct laryngoscopy 
    • A procedure that uses general anesthesia
    • This method allows the doctor to view the vocal folds and other parts of the larynx under high magnification
    • Usually used to minimize discomfort, especially with children, or to allow the doctor to biopsy tissue samples from the larynx or other parts of the throat for diagnosis 

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What Is the Treatment for Laryngeal Papillomatosis?

There is currently no cure for laryngeal papillomatosis. 

The main treatment is surgery to remove tumors from the larynx or airway. Laser surgery is preferred because traditional surgery can cause problems due to scarring of the larynx tissue.  

Even after tumors are removed, it is common for them to return and for patients to require multiple surgeries. In some patients, surgery may be required as frequently as every few weeks to keep breathing passages open. 

In extreme cases where there is aggressive tumor growth, a tracheotomy may be performed. An incision is made in the front of the patient’s neck and a breathing tube (trach tube) is inserted through an opening (stoma) into the trachea (windpipe) and patient breathes through the trach tube instead of the mouth and nose. This is often used for a short time; however, some patients need a trach tube for a longer period to keep the airways open. This can cause difficulty speaking and patients may need to see a voice specialist or speech-language pathologist to learn to use their voice with the use of a speaking valve. 

In severe cases, drug treatments may be used in addition to surgery, including:

  • Antivirals such as interferon and cidofovir, which block the virus from making copies of itself
  • Indole-3-carbinol, a cancer-fighting compound found in cruciferous vegetables such as broccoli and brussels sprouts
  • Bevacizumab, which targets the blood vessel growth of papilloma

How Do You Prevent Laryngeal Papillomatosis?

Laryngeal papillomatosis can be prevented by vaccination with the HPV vaccine. The Centers for Disease Control (CDC) currently recommends all children (boys and girls) receive the HPV vaccine at age 11 or 12. 

Talk to your child’s doctor whether the type of HPV vaccine your child will receive will protect against HPV 6 and 11. 

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Reviewed on 6/11/2021
References
https://www.nidcd.nih.gov/health/recurrent-respiratory-papillomatosis