Recurrent laryngeal papillomatosis
What’s that?
Recurrent laryngeal papillomatosis is localized benign overgrowths provoked by the causative agent of papillomavirus infection.
About the disease
Papillomatosis refers to a chronic benign disease in which there is the formation of wart-like growths of the mucous membrane of the larynx. The morphologic unit is a papilloma. The share of papillomas in the structure of benign laryngeal pathology ranges from 15 to 55%. The disease is equally common in both women and men.
Papilloma is a localized overgrowth of epitheliocytes of squamous or transitional epithelium. The disease is characterized by an increased recurrence rate, progressive course, and narrowing of the laryngeal lumen. First, the function of the vocal cords is affected, and then the air passage through the respiratory tract is impaired.
The leading cause of laryngeal papillomatosis is the papillomavirus, which can enter the body in ways other than sexual transmission. HPV can be transmitted from mother to fetus, causing laryngeal papillomatosis, and is capable of affecting trophoblast cells, which can lead to spontaneous abortions. In adults, laryngeal papillomatosis may be associated with orogenital contact.
The primary method of treatment is endolaryngeal surgery. It is performed using microscopical instrumentation. Electric coagulation or laser destruction is used to prevent dissemination of the process. However, isolated surgical treatment does not prevent the recurrence of the disease, so the complex treatment includes measures for counter-relapse therapy.
Types
In otolaryngology, two forms of laryngeal papillomatosis are distinguished:
- juvenile form;
- laryngeal papillomatosis in adults.
These two forms have the same histologic structure. The difference lies in the clinical features of the disease. Thus, juvenile forms are more likely to recur, and lesions are more prevalent. In turn, in adult-type laryngeal papillomatosis, there is an increased likelihood of malignization – malignant transformation of papilloma with the development of squamous cell cancer.
Symptoms of laryngeal papillomatosis
In some cases, laryngeal papillomatosis is benign, while in others, it is characterized by progression with the development of complications, in particular, laryngeal stenosis, which can be both acute and chronic. Often, the first sign of the disease is a change in the timbre of the voice, hoarseness. With the narrowing of the laryngeal lumen, dyspnea appears, and it is difficult to inhale and exhale. Increasing oxygen deficiency leads to weakness, decreased efficiency, and physical endurance. Thus, the symptoms of laryngeal papillomatosis are not specific.
Laryngeal papillomas in adults are considered an obligate precancer. Squamous cell carcinoma can develop between 19 and 35 years of age from the first growths on the laryngeal mucosa.
Papillomatosis from the primary focus can spread to neighboring organs. Such a course of the disease is more characteristic of the juvenile form. In this case, the pathological process can affect the oral cavity, tracheobronchial tree, lungs, and esophagus.
Causes of laryngeal papillomatosis
The disease is caused by the papillomavirus, which contains two DNA strands as genetic material. This pathogen belongs to the parvovirus family. This virus can be contained in the tissue that surrounds the papillomas. Cases of recurrence of the disease are associated with this fact.
Papillomavirus infection can be latent for a long time. Activation of viral replication usually occurs against the background of transient immunodeficiency, which can be caused by concomitant disease, traumatic injury, acute respiratory infection, etc. Disease recurrences are usually associated with papillomavirus types 6 and 11.
The specificity of HPV in relation to genital organs suggested that the main route of transmission is the sexual route. Orogenital contacts play a significant role in the occurrence of laryngeal papillomatosis. However, the virus can be detected even in virgins and children in the first year of life. In this case, the most likely route of transmission is vertical. Thus, HPV is found in amniotic fluid, increasing the risk of infection of children in utero.
Diagnosis of laryngeal papillomatosis
Diagnosis of laryngeal papillomatosis is based on the results of pharyngoscopy. Endoscopic examination of the mucosa allows you to detect local pathological formations. What do they look like? Papilloma is a wart-like neoplasm with a rough surface, usually comparable in color to the surrounding epithelium. For final verification of the nature of the local process, PCR testing is performed to determine the degree of oncogenicity of papillomavirus strains.
Treatment of laryngeal papillomatosis
Surgical interventions and anesthesia often lead to suppression of the immune response, especially its cellular component. In this regard, in the treatment of laryngeal papillomatosis, a combined method of treatment is widely used, which includes, along with surgical treatment, various methods of antiretroviral therapy.
Conservative treatment
The basis of drug treatment consists of drugs that help increase the immune system’s antiviral activity. In some cases, the use of antibiotics is also justified. These drugs help to destroy the bacterial flora, which can aggravate the course of the disease.
Surgical treatment
The modern treatment concept for laryngeal papillomatosis involves the removal of papillomas using endoscopic instrumentation. It allows to cope with such manifestations of the disease as voice disorders, narrowing of the lumen of the respiratory tract, etc. After surgery, some patients may experience a recurrence. Sometimes, this can be the continued growth of papillomas. Therefore, the combination of careful removal of papillomas and careful treatment of the surrounding tissues is an essential factor affecting the duration of remission and prevention of complications.
Laser surgery for laryngeal papillomatosis is another option for modern surgical care. Such interventions allow bloodless surgery with a good view of the operative field and the possibility of removal of the papillom without damaging the mucosa’s basal membrane in any part of the larynx. It prevents excessive scarring in the postoperative period and the occurrence of reactive phenomena after surgical intervention.
All these treatment options are available in more than 260 hospitals worldwide (https://doctor.global/results/diseases/recurrent-laryngeal-papillomatosis). For example, total laryngectomy can be done in 13 clinics across Turkey for an approximate price of $8.8 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/total-laryngectomy).
Prevention
Prophylaxis is aimed at preventing papillomavirus infection. For this purpose, it is recommended:
- avoid random sexual intercourse;
- use a condom;
- get lab tests before getting pregnant;
- be immunized with a polyvalent HPV vaccine before sexual intercourse.
Rehabilitation
After surgery, the following remedies may be used to prolong remission and prevent recurrence:
- Antitumor drugs. However, when used systemically, these drugs cause a pronounced toxic effect.
- Immunomodulatory drugs.
- Interferons are administered primarily locally in the larynx. These agents exhibit antitumor, immunomodulatory, and antiviral activity.
