What Are Recurrent Laryngeal Papillomatosis, HPV Warts and Papillomas?

Diseases involving recurring respiratory tract warts are called recurrent respiratory papillomatosis . These benign (noncancerous) tumors can occur anywhere from the mouth and throat through the airways to the lungs. Although they can grow anywhere in the respiratory tract, they most often develop around the vocal cords, called laryngeal papillomatosis. Papillomas vary in size and some grow very quickly.

What Causes Recurrent Laryngeal Papillomatosis?

The main cause is two human papillomavirus (HPV) types. More than 150 types exist, with varying symptoms; some cause none. In a small number exposed to HPV 6 or 11, respiratory papillomas and genital warts can develop. The virus is generally transmitted through sexual contact or from an infected mother to baby. 

- Related Topic: What Is HPV – Human Papillomavirus, and How Does It Cause Cancer?

Who Does Recurrent Laryngeal Papillomatosis Affect?

It can occur in adults, babies and young children. An infected mother may transmit HPV during vaginal or cesarean delivery. Among children younger than 18, it occurs in two per 100.000.

- Related Topic: Can HPV Pass From Mother to Baby During Pregnancy? How Is It Transmitted, and Can It Be Prevented?

What Are the Symptoms?

Most commonly;

• Hoarseness,
• Dyspnea (shortness of breath),
• Chronic cough

Vocal cord papilloma complaints are more severe in children. Rapid growth may cause young children difficulty breathing while asleep and swallowing.

Their similarity to asthma or chronic bronchitis symptoms sometimes complicates diagnosis.

The figure aboveshows airway sites where HPV-related papillomas can occur.

How Is Recurrent Laryngeal Papillomatosis Diagnosed?

ENT or thoracic surgery specialists can view papillomas with rigid (inflexible) or flexible laryngoscopes.

Rigid or direct laryngoscopy is performed under general anesthesia in an operating room; this is preferred for children to minimize discomfort. Flexible laryngoscopy can use local anesthesia. During either procedure, a wart-like papilloma may be completely removed and tissue sampled by biopsy.

Microscopic examination in the pathology laboratory establishes the diagnosis. Tissue can also undergo polymerase chain reaction testing to identify HPV DNA and subtype.

How Is It Prevented or Treated?

HPV vaccination may prevent recurrent airway warts. All children aged 11-12, boys and girls, are recommended vaccination. Once airway warts develop, there is currently no complete cure. Surgery is the main method to remove laryngeal or airway tumors. Many surgeons now use lasers, and other wart-removal techniques are also available.

- Related Topic: The Story Behind HPV Vaccine Discovery

Tumors can recur after removal, and multiple operations are common. Some patients need surgery every few weeks to keep the airway open; others need it annually or less often.

Severe cases may receive treatments in addition to surgery, including antiviral drugs such as interferon and cidofovir that prevent viral replication.

Scientists and clinicians continue studying this condition. Although HPV 6 and HPV 11 are known causes, millions encounter these viruses without developing disease. Why some face greater risk or more severe disease is unknown.

Research currently identifies HPV vaccination as the most effective prevention. Therapeutic HPV vaccine research also continues, as do studies testing, for HPV-infected papillomas, immunotherapies as treatment.

Related Topics

- From World War 2 to the Nobel Prize: Dr. Harald zur Hausen and the Discovery That HPV Causes Cervical Cancer

- The Link Between Head and Neck Cancers and HPV