Vocal cord papillomas, also known as recurrent respiratory papillomatosis, are wart-like growths that develop on the larynx. Papillomas are surface lesions that grow out from the vocal fold mucosa. In individuals with immune conditions, papillomas may also occur in the mouth, throat, or lungs.
What Causes Vocal Cord Papillomas?
Vocal cord papillomas are caused by the human papilloma virus, also known as HPV. The human papilloma virus is typically transmitted from person to person through intimate contact; however, not everyone who is infected develops the growths. The development of papillomas may depend on the ability of the individual’s immune system to fight the virus. Papillomas are not associated with excessive vocal cord use.
Who is at Risk for Papillomas?
Vocal cord papillomas most often affect young children. A child can become infected with the human papilloma virus during the birth process if the mother has genital warts caused by HPV. A less aggressive form of the disease can also affect adults. Papillomas in adults typically grow slower than those in children and are less likely to develop outside of the larynx.
What Are the Symptoms of Vocal Cord Papillomas?
Papillomas are normally painless, but they can cause hoarseness or obstruct the airway depending on their size.
Diagnosing Vocal Cord Papillomas
Papillomas have an irregular surface with a stippled, raspberry-like appearance. The growth may affect a single area of the vocal fold or the entire length of one or both vocal folds.
Treatment of Vocal Cord Papillomas
There is no actual cure for papillomas; however, surgical excision may help keep the growths in check. Like any other wart, vocal cord papillomas have a high incidence of recurrence even with complete excision.
Traditionally, papilloma excision was performed in an operating room and involved using a laryngoscope, laser, and fine instruments to remove the papilloma through the mouth. Today, minimally invasive techniques are available to remove the diseased tissue while leaving the healthy tissue intact. The procedure, which involves passing a camera and laser through the nose, can be completed in the office in approximately 20 minutes. Patients are allowed to go home the same day, and there is no need for extensive time off from school or work.
In the event of disease recurrence, voice quality and function must be taken into consideration. Cumulative damage and scarring from repeated surgeries can impair vocal fold vibration resulting in permanent voice changes. The need for repeat surgery is determined by the size of the growth and the degree of impairment to the voice.
Investigational therapies may provide a viable treatment option for individuals with multiple recurrences requiring frequent surgery. One treatment involves the antiviral drug cidofovir. In some patients, the drug has eliminated papilloma recurrences when injected directly into the lesions. The therapy is still under investigation to determine the optimal frequency of administration and dosing. Therapies that modify the immune system to better fight the virus are also being considered.