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Laryngeal papillomatosis

Victory over papillomatosis is possible!
15 surgeries in anamnesis. Many patients report about dozens of surgeries in anamnesis and endless relapses. It seems that it is impossible to cope with this disease. Each time the voice is getting worse and worse, numerous scars are being formed in the larynx. It is a thing of the past.
For the moment, the understanding that papillomatosis is localized exclusively in the mucous membrane of the vocal fold, allows to excise them fully, but conservatively. It means that the surgery should be performed only in the surperficial layers without affecting the important anatomical structures of the vocal fold and not to lead to a hoarseness and scarification.
Laryngeal papillomatosis
Laryngeal papillomatosis
Medical advancement helps. The main thing is to keep up to date with the progress and to take all opportunities. The use of CO2 laser, narrow-spectrum endoscopy and certain antiviral medication are such opportunities to treat papillomatosis. The indispensable condition to achieve the best result is that everything must be done by a highly qualified surgeon with a wealth of experience in the treatment of laryngeal papillomatosis. It is of utmost importance.

Papillomatosis is characterized by the formation of exophytic growths that affect the mucous membrane of various parts of the larynx and the lower parts of respiratory tract.

Risk factors

The etiological factor is the human papillomavirus (HPV) in most cases 6 and 11 types. The latter leads to a severe acute disease. Laryngeal papillomatosis can be rarely caused by HPV 16 and 18 types, which are viruses at high risk of cancer. However, the presence of HPV in the human respiratory tract does not always cause papillomatosis. Immunodeficiency, persistent infections may be the determining factors. Coincident infection of HSV (herpes simplex virus) and EB virus (Epstein-Barr virus) are the cause of a more aggressive course of disease.

Symptoms

Symptomatically, laryngeal papillomatosis can be represented by hoarseness, chronic cough, bad breath, difficulty in swallowing, recurrent respiratory infections and children’s stunted growth. The presence of certain symptoms depends on the location of papillomas. The symptoms are more marked among children as they have a much faster growth compared to adults. It can lead to the situations when life-saving emergency surgery must be performed despite the benign character of the disease. Favorable prognosis happens to be if the symptoms of disease are detected in adulthood. The exception is the presence of HPV 11 type and the duration of the disease for more than 10 years.

Possible methods of treatment

  • Careful removal of papillomatosis growths under a microscope
    and using a CO2 laser is fundamental. However, the excision should be carried out exclusively within the mucosa, where the formations are located. What is more, the normal mucosa should be preserved. The surgeon must be experienced and thoroughly understand the mechanism of papilloma formation. If not, rough surgery leads to voice loss, excessive scarification, stenosis.


  • Intraepithelial administration of antiviral drugs can reduce the number of surgeries to excise papillomas, leading to partial regression of formations growth. At the same time local administration of antiviral drug can help to avoid systemic toxicity.

  • The mechanism of interferons action in laryngeal papillomatosis is unknown, however, they are often used as an additional treatment. Interferons are naturally produced by leukocytes in response to various stimuli, including the viral infection. They are bound to specific cell membrane receptors and alter metabolism, providing antiviral, antiproliferative and immunomodulatory effects. Clinical success rates of interferons are questionable and contradictory in the treatment of laryngeal papillomatosis. The main limitation for their use is the side effects of intravenous injenctions: increased level of transaminases, leukopenia and thrombocytopenia. Patients may experience weakness, nausea, fever, arthralgia and headach
  • Indol-3-carbinol можно извлечь из крестоцветных растений (брокколи, капуста). В in vitro исследованиях были получены многообещающие результаты по воздействию на рост папиллом путем воздействия на метаболизм эстрогенов. При пероральном введении небольшому количеству пациентов детской возрастной группы неблагоприятных эффектов отмечено не было. Однако, клиническая эффективность данного препарата остается под сомнением.
  • Vaccine against measles, mumps and rubella (MMR). Prospective randomized controlled study has shown that intraepithelially introduced MMR vaccine may prolong the period of remission after surgical treatment.
  • HspE7. The new vaccine, which targets oncogenous HPV types, has also been used for successful control of the recurrence of laryngeal papillomatosis
  • The presence of GERD was associated with an increased risk of complications. An irritating effect on the mucous membrane can act as a trigger for proliferation and spread of papillomatosis growths. According to the studies, the use of drugs for the GERD treatment contributes to better control of laryngeal papillomatosis and prolongs remission.

  • According to the Cochrane review, photodynamic therapy is not proven to be effective in the treatment of laryngeal papillomatosis.

Effective modern treatment

The key to success is the complex approach starting from a detailed diagnosis using cutting-edge technologies to a thorough control in the postoperative period. As well as precise papillomas excision, Professor Puxeddu performs targeted injection of antiviral drugs in the mucosa of the certain regions of the larynx. For more than 10 years all patients who underwent Professor Puxeddu’s treatment haven’t had the recurrence of the disease.


Roberto Puxeddu
Roberto Puxeddu
Professor, Chairman, Division of Otorhinolaryngology, Department of Surgery, University of Cagliary

Laryngeal papillomatosis

Laryngeal papilomatosis
Postoperative observation papilomatosis
Postoperative relapse-free period of follow-up control

Endoscopy in the mode of NBI

To sum up

Laryngeal papillomatosis changes a person’s life aggressively, in many cases from early childhood. Hoarseness is the most favorable symptom, compared with impairment of breathing and dozens of operations in anamnesis. The main target of treatment is the long term remission which is achieved exclusively by a comprehensive approach and a quality excision of papillomatous growths. The surgery is performed under general anesthesia transorally, using a microscope and a CO2 laser.

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Natalia Chuchueva

Assistant Professor, Department of ear, nose and throat disease, Sechenov University, Moscow.
ENT-specialist, health centre "Barviha" Presidential Affairs.

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