Laryngeal papillomas are one of the clinical manifestations
of respiratory papillomatosis in children, which can involve
mucosa of the nose, mouth, and oropharynx. Human
papilloma virus types 6 and 11 usually cause the infection.
This is essentially a disease process that involves all
respiratory mucosa, as evidenced by the finding of viral
genome in normal mucosa.
Children present with a hoarse, weak
voice in the early stages. With progressive disease, chronic
cough and mild inspiratory stridor become evident. With
higher load of papillomas, severe airway compromise occurs
with stridor, use of accessory muscles, and features of
carbon dioxide retention, which is a vanishingly rare
presentation these days.
The characteristic finding of solitary or often multiple
warty lesions with an irregular
surface on flexible nasolaryngoscopy establishes the
diagnosis. Histological confirmation should be
obtained prior to treatment.
Spontaneous resolution may occur as the patient grows
older. Repeated intervention, based on the growth of the
papillomas, is needed to control symptoms and maintain the
airway. Tracheostomy is to be avoided as it can enhance
spread to the lower airways.
Treatment involves debulking the papilloma by
mechanical means (laser or microdebrider)
to remove the obvious lesions.
Care must be taken to avoid damage to
normal adjacent tissue to minimize
disruption of the voice. Systemic treatment with antivirals
has fallen out of favour due to side-effects. There is
resurgence for medical treatment using local antivirals like
cidofovir, but this is used in a controlled setting.