Laryngeal papillomatosis is a challenging disease affecting children and adults. Human papilloma virus causes growths of the vocal cords leading to hoarseness. In severe cases (especially in children) airway obstruction. The throat warts can be asymptomatic if they do not involve the vocal cords. Papilloma can affect the palate, nose, trachea, lungs, subglottis, epiglottic, and false vocal cords. Transmission occurs sexually, or in the case of juvenile papillomatosis from a mother infected with the virus. In rare cases, though, infants can become infected despite being delivered via C-section. This may be due to inocculation during labor prior to the decision to perform C-section.
Treatment is aimed at gentle removal of laryngeal papillomas, preserving the integrity of the vocal cords. Unfortunately, despite careful surgery, papillomatosis recurs at a variable rate. In children surgery needs to be performed as frequently as every few weeks. In adults the rate of recurrence can also be quite rapid.
Treatment modalities in surgery include the angiolytic lasers (pulsed KTP laser and pulsed dye laser), CO2 (Carbon Dioxide) laser, microdebrider (shaver), and cord instrument excision. Angiolytic lasers target the blood supply of the papillomas, which is more dense than the surrounding normal tissue. They act as "smart" lasers, avoiding thermal injury to uninvolved tissue. In the past 8 or 9 years, laser surgery for laryngeal papillomatosis has been performed in the office setting without sedation. For patients requiring surgery every few months this is a major convenience as far as ability to return immediately to work with no downtime.
Adjuvant treatments exist to modulate the rate of recurrence of papilloma. There are many options. Cidofovir is an antiviral drug that is injected into papilloma. It has been linked inconsistently to pre-cancerous changes in papilloma, though largely it appears to be safe. It also has the potential to cause scarring of the vocal cords and should be used cautiously on the vocal folds for this reason. Avastin is an anti-angiogenic drug preventing growth of the blood vessels feeding papilloma. Avastin has been injected for laryngeal papillomatosis for the past 2 years or so, and so far there has been only one report on its efficacy. There is an ongoing clinical trial looking at the drug and papilloma.
At Newport Voice and Swallowing both Cidofovir and Avastin are offered for laryngeal papillomatosis. We offer unsedated office-based laryngeal surgery for papilloma using the pulsed KTP laser, and at the present time we are the only center in Orange County offering the treatment.
Below is an interesting article about Avastin and recurrent respiratory papillomatosis.