Laryngeal Papilloma
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Laryngeal papillomatosis is a disease consisting of tumors that grow inside
the larynx (voice box), vocal cords, or the air passages leading from the
nose into the lungs (respiratory tract). It is a rare disease caused by the
human papilloma virus (HPV). Although scientists are uncertain how people
are infected with HPV, they have identified more than 60 types of HPVs. Tumors
caused by HPVs, called papillomas, are often associated with two specific
types of the virus (HPV 6 and HPV 11). They may vary in size and grow very
quickly. Eventually, these tumors may block the airway passage and cause difficulty
breathing.
Laryngeal papillomatosis affects infants and small children as well as adults.
Between 60 and 80 percent of cases occur in children, usually before the age
of three. Because the tumors grow quickly, young children with the disease
may find it difficult to breathe when sleeping, or they may experience difficulty
swallowing. Adults with laryngeal papillomatosis may experience hoarseness,
chronic coughing, or breathing problems.
There are several tests to diagnose laryngeal papillomatosis. Two routine
tests are indirect and direct laryngoscopy. An indirect laryngoscopy is done
in an office by a speech-language pathologist or by a doctor. To examine the
larynx for tumors, the doctor places a small mirror in the back of the throat
and angles the mirror down towards the larynx. A direct laryngoscopy is performed
in the operating room under general anesthesia.
This procedure is usually used with children or adults during lengthy
examinations to minimize discomfort. It involves looking directly at the
larynx. Direct laryngoscopy allows the doctor to view the vocal folds and
other parts of the larynx under high magnification and samples of unusual
tissue lesions that may be in the larynx or other parts of the
throat.
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Many forms of treatment have been used to remove laryngeal papillomas
such as surgery, chemotherapy, or antibiotic therapy. Currently,
traditional surgical removal of the tumors and another technique, carbon
dioxide laser surgery, are both used. Carbon dioxide laser surgery uses
intense laser light as the surgical tool.
Once they have been removed, these tumors have a tendency to return
unpredictably. It is not uncommon for patients to require repeat surgery.
With some patients, surgery may be required every few weeks in order to
keep the breathing passage open, while others may require surgery only
once a year. In the most extreme cases where tumor growth is aggressive, a
tracheotomy may be performed. A tracheotomy is a surgical procedure where
an incision is made in the front of the patient's neck and a breathing
tube (trach tube) is inserted through a hole, called a stoma, into the
trachea (windpipe). Rather than breathing through the nose and mouth, the
patient will now breathe through the trach tube. Although the trach tube
keeps the breathing passage open, doctors try to remove it as soon as it
is feasible. However, there may be some patients who may be required to
keep a trach tube indefinitely in order to keep the breathing passage
open. In addition, because the trach tube re-routes all or some of the
exhaled air away from the vocal cords, the patient may find it difficult
to speak. With the help of a voice specialist or speech-language
pathologist the patient learns how to reuse the voice.
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Scientists have developed a new technique using photodynamic therapy
(PDT). With PDT, a physician injects a special dye that is sensitive to
bright light into the blood stream. This dye collects in tumors but not
healthy tissue, and when the dye is activated by a bright light of a
specific wavelength, the tumors that absorbed the dye are destroyed. In
addition to eliminating the tumors using PDT, scientists found that tumor
regrowth decreased, even for patients with the most severe form of the
disease.
PDT was first developed to kill certain tumors in humans. Although
treatment was promising, results were inconsistent and the technique was
soon abandoned. However, recent research shows that treating patients with
laryngeal papillomatosis using PDT appears to control tumor growth. The
development of newer forms of the dye has contributed to the resurgence of
this promising form of treatment may prevent patients from having multiple
surgical procedures.
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American Laryngeal
Papilloma Foundation (ALPF)
International Recurrent Respiratory
Papillomatosis (RRP) Information, Service, and Advocacy Center
Recurrent Respiratory Papillomatosis
Foundation (RRPF)
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