RESULTS: In Leeds seven cases presented to the specialist centre over the past 12 years, the average age at presentation was 6.8 years and duration of onset of symptoms to specialist review was 21 months. [ncbi.nlm.nih.gov]

Babies born vaginally to mothers with genital warts have a high risk of developing laryngeal papilloma. 3 They present with hoarseness, but more advanced cases present with stridor and respiratory distress. 2 Other presentations: Chronic cough, choking [waent.org]

Presentation and Treatment: Patient usually presents with Hoarseness of voice and Occasional cough. Indirect laryngoscopy shows polypoidal mass. Fiber optic laryngoscopy (F.O.L) can also be done. [pedimedicine.com]

• Surgical Procedure

  Abstract For the past 10 years, children with juvenile laryngeal papillomas have been treated with medical and surgical procedures at the many otolaryngology departments in Thailand. [ncbi.nlm.nih.gov]

  An interactive DVD ROM of intraoperative photographs and videos of surgical procedures is included to help illustrate the techniques described in the book. [books.google.com]

  […] excision is the current standard of care in the treatment of RRP Surgery is emergent if there is airway obstruction Numerous surgeries may be needed because of the recurrence of these tumors (>100) Adult form requires fewer surgical procedures Tracheostomies [learningradiology.com]

  A distinguishing aspect of this disease is the tendency for the papilloma to recur after surgical procedures to remove them. Hence, the "recurrent" part of the name. [rrpf.org]

  The goal of any surgical procedure is to remove as much of the papillomatosis as possible without scarring the vocal cords, which may result in irreversible hoarseness. [professionalvoice.org]

• Pain

  Free Education | November 2014 Laryngeal Papillomatosis Author Notes From the Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts (L.R.K.U.). [anesthesiology.pubs.asahq.org]

  They are usually not considered dangerous unless it causes discomfort or pain. Surgery is done to remove a papilloma. [pedimedicine.com]

  Please give your child pain relief (paracetamol or ibuprofen) according to the instructions on the bottle. You will be sent the date for a follow up appointment either in the Outpatients department or to come back to the hospital for another stay. [gosh.nhs.uk]

  Symptoms of the disease include: Hoarseness of voice, a sore throat, pain when swallowing, earache, and enlarged lymph nodes. The cancer is most commonly located at the base of the tongue, that is, in the oropharynx and on the tonsils. [news-medical.net]

• Pathologist

  If you're experiencing hoarseness or a strained or breathy voice, otolaryngologists and speech-language pathologists of the Jefferson Voice and Swallowing Center in Philadelphia can diagnose your condition with a biopsy or a laryngoscopy. [hospitals.jefferson.edu]

  A 100% accurate diagnosis requires collaboration between a laryngeal surgeon (aka laryngologist) and pathologist. [professionalvoice.org]

  With the help of a voice specialist or speech-language pathologist who specializes in voice, the patient can learn to use his or her voice with the use of a speaking valve. In severe cases of RRP, therapies in addition to surgery may be used. [nidcd.nih.gov]

  Some otolaryngologists or speech pathologists may use a videostroboscopy to obtain an even more detailed look. [rrpf.org]

  Histology was confirmed in all cases before HPV testing and DNA was only extracted from representative tumor tissue selected by an experienced ear, nose and throat pathologist. [journals.plos.org]

• Inflammation

  Swelling and inflammation in areas with papillomas can exacerbate voice complaints or breathing difficulty. [voicefoundation.org]

  One week after the procedure, the patient still had difficulty speaking owing to postoperative inflammation. He was prescribed continuous vocal rest and anti-inflammatory agents. [bmcresnotes.biomedcentral.com]

  One week after second removal (6 of 8) A week after second removal of papillomas and cidofovir injection, with expected inflammation, but no visible remaining stippled vascularity. 4 months later, healed (7 of 8) 4 months later, the vocal cord has long [laryngopedia.com]

• Malaise

  Although some investigators have reported success with the use of interferon for the treatment of aggressive RRP, frequent side effects such as fatigue, dizziness, malaise, body aches, headache and fever, as well as a propensity for the papillomas to [ucdvoice.org]

  […] recurrence In children without a response, stop administration Observe for rebound in RRP after discontinuation of alpha-interferon Side effects (frequent) Side effects frequently seen on initiation disappear with continued use (tachyphylaxis) Fatigue, malaise [medicine.uiowa.edu]

• Hoarseness

  CONCLUSION: The take home message for clinicians is hoarse voice associated with shortness of breath needs specialist referral. © 2012 Blackwell Publishing Ltd. [ncbi.nlm.nih.gov]

  The typical symptom is hoarseness but occasionally the papillomas become large enough to cause airway symptoms with difficulty breathing. [hospitals.jefferson.edu]

  It presents with papilloma involving the supraglottis and glottis with complaints of progressive hoarseness, stridor and dyspnea. Adult onset papilloma are usually solitary and mainly involve the glottis, with the main symptom being hoarseness. [waent.org]

  Moreover, any minor to major degree of hoarseness constitutes an indication for surgical intervention. [wohlt.com]

• Pneumonia

  […] recurrence rate may lead to numerous operative removals Not the same as vocal cord polyps or nodules Clinical Findings Children usually present around age 2-3 with Male:female ratio 1:1 Cough, hacking in nature Audible wheezing Hemoptysis Stridor Dysphagia Pneumonia [learningradiology.com]

  Other less common symptoms include chronic cough, pneumonia, and shortness of breath.4 Preliminary diagnosis is made by visualizing the vocal folds. [questia.com]

  […] vaginally to mothers with genital warts have a high risk of developing laryngeal papilloma. 3 They present with hoarseness, but more advanced cases present with stridor and respiratory distress. 2 Other presentations: Chronic cough, choking, recurrent pneumonia [waent.org]

  Ribavirin: is an antiviral drug used to treat pneumonia in infants caused by respiratory syncytial virus has shown some promise in the treatment of aggressive papillomatosis. Copyright drtbalu 2007 [drtbalu.co.in]

  […] or tracheal parts of the airway, shortness of breath, chronic cough and stridor (i.e. noisy breathing which can sound like a whistle or a snore), can be present. [4] [5] As the disease progresses, occurrence of secondary symptoms such as dysphagia, pneumonia [en.wikipedia.org]

• Respiratory Distress

  Tracheostomy should be done if the patient has severe respiratory distress. Progress: Most papillomata disappear by puberty. The chances of recurrence are considerably reduced after use of laser surgery. [specialist-ent.com]

  Usual clinical presentation is seen with hoarseness, stridor and respiratory distress, depending on the site and extent of laryngeal involvement of the disease. [waent.org]

  Conclusion Anesthetic management of laryngeal papilloma needs special attention as the lesion can obstruct already narrow pediatric airway, in addition anxiety and respiratory distress in the child makes it more challenging to the anesthesiologist. [saudija.org]

  Respiratory distress - None - 0, Mild - 1, Moderate - 2, Severe - 3, Extreme - 4. Anatomical score: For each site - 0 = none, 1=surface lesion, 2= raised lesion, 3=bulky lesion. [drtbalu.co.in]

  distress syndrome, failure to thrive, and recurrent upper respiratory infections can be diagnosed. [4] [5] The risk of laryngeal papillomatosis spreading to the lungs is higher in the juvenile-onset than the adult-onset. [3] In children, symptoms are [en.wikipedia.org]

• Rhinorrhea

  There was a mild lateral supraglottic constriction, and absence of posterior rhinorrhea. [bmcresnotes.biomedcentral.com]

• Dysphagia

  Then, later in life, the patient had progressive breathlessness and dysphagia. On examination, he had supraclavicular lymphadenopathy showing squamous carcinoma pathology. [ijmpo.org]

  Significant recurrence rate may lead to numerous operative removals Not the same as vocal cord polyps or nodules Clinical Findings Children usually present around age 2-3 with Male:female ratio 1:1 Cough, hacking in nature Audible wheezing Hemoptysis Stridor Dysphagia [learningradiology.com]

  One of the main complaints with these types of lesions is speech alteration (dysphonia), as reported in the present case, and deglutition (dysphagia)[ 6 ]. [bmcresnotes.biomedcentral.com]

  […] genital warts have a high risk of developing laryngeal papilloma. 3 They present with hoarseness, but more advanced cases present with stridor and respiratory distress. 2 Other presentations: Chronic cough, choking, recurrent pneumonia, dyspnea, and dysphagia [waent.org]

  […] the laryngeal or tracheal parts of the airway, shortness of breath, chronic cough and stridor (i.e. noisy breathing which can sound like a whistle or a snore), can be present. [4] [5] As the disease progresses, occurrence of secondary symptoms such as dysphagia [en.wikipedia.org]

• Hyperkeratosis

  Verruca vulgaris - have granular layer, hyperkeratosis and parakeratosis. [2] Oral condyloma - broader projections with a blunted appearance. [2] Images SP - very low mag. SP - low mag. SP - low mag. SP - intermed. mag. [librepathology.org]

  Histopathology of the biopsy showed stratified squamous epithelium with hyperkeratosis, acanthosis, papillomatosis with fibrovascular core, suggestive of squamous papilloma (See pictures below). [waent.org]

  Adults, more often have papillomas on the Ferrein's cords, which are characterized by hyperkeratosis. The main symptom of both children and adults is increasing hoarseness, reaching the full aphonia. [iliveok.com]

  Epithelial maturation abnormalities also occur, including hyperplasia of the basement membrane; dyskeratosis, which is premature keratinization in cells that are not in the keratinizing surface layer of the skin; and hyperkeratosis, which is thickening [bcm.edu]

Workup resulted in a diagnosis of multiple laryngeal papillomas [Figure 1]. Breathlessness in laryngeal papillomas is because of air flow obstruction due to structural interference. [ijmpo.org]

Microdirect Laryngoscopy (Suspension Microlaryngoscopy or Direct Laryngoscopy) Good example of positioning/setup: Microdirect Laryngoscopy case example Repeat DL/B with videorecording at least every eight to 12 weeks Baseline CXR, repeated annually Additional workup [medicine.uiowa.edu]

Clinical Testing and Workup An indirect laryngoscopy involves holding a small mirror in the back of the throat. An ENT physician will reflect light off the mirror to illuminate the throat and detect the presence of papillomas. [rarediseases.org]

In 8 patients where complete remission has been achieved, the mean number of laser treatments was 5.3. [ncbi.nlm.nih.gov]

This additional treatment can be performed either in the operating room along with KTP laser treatment or, in many patients, as an office-based procedure. [northshore.org]

In adults there may be a papilloma regeneration into a cancer or sarcoma, and then the prognosis depends not on the primary disease, but on its complications. Prognosis depends on the prevalence and frequency of recurrence. [iliveok.com]

Treatment and prognosis Although respiratory papillomas tends to be slow growing, treatment is usually ineffective with high recurrence rate (~ 90%). [radiopaedia.org]

[…] that are being tried include Interferon Photodynamic therapy Indol-3-carbinol Ribavirin Acyclovir Methotrexate Mumps vaccine Cidofovir It is hoped that widespread use of anti-HPV vaccines (Gardisil) will eventually lead to eradication of the disease Prognosis [learningradiology.com]

Adult respiratory papillomatosis: Human papillomavirus and viral coinfections as predictors of prognosis. Ann Otol Rhinol Laryngol. 1995; 104:758-762 22. Bielamowicz S, Villagomez, V, Stager S, Wilson W. [the-medical-dictionary.com]

Adult respiratory papillomatosis: human papillomavirus type and viral coinfections as predictors of prognosis. Ann Otol Rhinol Laryngol. 1995;104(10):758–762. 19. Steinman L. [dovepress.com]

Bilateral Laryngeal Papilloma Laryngeal papillomas constitute 80% of the neoplastic lesions of the larynx Juvenile laryngeal papillomas are a type of squamous papillomas seen in infants and children Etiology: It is believed to be viral in origin (Human [pgblazer.com]

ETIOLOGY Although Bonjour 1 only thirteen years ago characterized the "theory of the contagiousness of warts" (and condylomata acuminata) as an error, their infectious character must be considered as proved. [jamanetwork.com]

Testing the biopsied tissue for HPV provides further evidence of the etiology of the lesion, and viral typing can be useful. Management of laryngeal papillomas commonly involves surgery, adjuvant therapy to eliminate viral replication, and vaccines. [questia.com]

In most cases, papillomas have a viral etiology which has been proven by several authors who have succeeded in reproduction of the tumor by autoinoculation of its filtrate. [iliveok.com]

A detailed epidemiologic questionnaire was administered at the initial visit. After enrollment, tissue obtained during each laryngeal surgery was examined by polymerase chain reaction assay for human papilloma virus (HPV) and typing. [ncbi.nlm.nih.gov]

Laryngeal papillomas: the epidemiology in a Danish subpopulation 1965–1984. Clin. Otolaryngol. Apr,1990;15(2):125-31. DOI: https://doi.org/10.1111/j.1365-2273.1990.tb00444.x McKenna M, Brodsky L. [revistas.usal.es]

"Epidemiology of recurrent respiratory papillomatosis". APMIS. 118 (6–7): 450–454. doi : 10.1111/j.1600-0463.2010.02619.x. ISSN 1600-0463. PMID 20553527. ^ a b c d e f g Barnes, Leon (2005). Pathology and genetics of head and neck tumours (PDF). [en.wikipedia.org]

(managed by the Centers for Disease Control), there is still a lack of a comprehensive epidemiological database of RRP patient information. Hence, it is difficult to determine incidence and prevalence statistics with a high degree of confidence. [rrpf.org]

Cruciferous vegetables and human cancer risk: epidemiologic evidence and mechanistic basis. Pharmacol Res. 2007 Mar. 55(3):224-36. [Medline]. Rosen CA, Bryson PC. Indole-3-carbinol for recurrent respiratory papillomatosis: long term results. [emedicine.medscape.com]

Pathophysiology HPV, the virus associated with cutaneous warts, genital condyloma, and cervical cancer, causes RRP. While more than 20 types of HPV can cause genital warts, only 2 of these, HPV-6 and HPV-11, cause the vast majority of cases of RRP. [emedicine.medscape.com]

The data demonstrated a single subtype of HPV to have persisted, and the prevention of a recurrence of laryngeal papilloma during our patient's long clinical course to have failed, in spite of the interferon treatment. [ncbi.nlm.nih.gov]

Vaccination before becoming sexually active is the most effective way to prevent the spread of the infection. HPV vaccination can help to prevent a new HPV infection but it cannot help in anyway if the individual is already infected with the virus. [medindia.net]

Eventually, research may help to develop new vaccine strategies to treat or prevent RRP. [nidcd.nih.gov]

It was also noted that the prescription of methionine after surgery in a dose of 0.5g 3 times a day for 3-4 weeks prevents relapses. [iliveok.com]

“Gardasil, Merck’s Cervical Cancer Vaccine, Demonstrated Efficacy in Preventing HPV-Related Disease in Males in Phase III Study: Pivotal Study Evaluating Efficacy of Gardasil in Males in Preventing HPV 6, 11, 16 and 18-Related External Genital Lesions [pvsf.org]