Don't Underestimate Hoarseness: Right Vocal Cord Papilloma

Human Papillomavirus (HPV) Infection on Right Vocal Cord

Right Vocal Cord Papilloma - Human Papillomavirus (HPV) Infection
Above is a photo of endoscopic larynx examination of the patient who presented with hoarseness, difficulty in speaking and scratchy sound. The lesion on the right vocal cord is puffed, white and irregular. Pathological examination of the mass revealed laryngeal papilloma (vocal cord papilloma, vocal cord papilloma, recurrent respiratory papillomatosis or glottal papillomatosis).

Human papilloma virus (HPV) Type 6 and 11 are usually caused by recurrent benign tumorous formations. They can grow up and block the airline. Sexual or oral mucosal transmission is discussed. Treatment options include carbon dioxide laser, surgical action and medical treatment. These patients should be closely monitored by an ENT specialist.

If there is hoarseness lasting more than two weeks, consult an otorhinolaryngologist!

The human body can show the same reactions in different diseases. In fact, hoarseness, which is a symptom of other ailments, can be caused by a simple infection, and hoarseness lasting more than two weeks can be a symptom of serious ailments.

Human papilloma virus (HPV) may also be one of the causes of hoarseness!

The human papilloma virus usually enters the larynx from the genital flora during birth and causes disease. Although the laser-induced mass is removed by laser, the main disadvantage of the disease is its high potential for recurrence. Therefore, laser surgery treatment can be repeated.

HPV can have consequences that mimic respiratory diseases and may cause hoarseness

There are many and different types of HPV, and some of them can cause laryngeal cancers, although some of these viruses do not have the same effect on everyone, and some do not cause any problems. HPV can have consequences that mimic respiratory diseases and may cause hoarseness, as in simple upper respiratory infections.

In babies, hoarseness can be caused by HPV!

Although it is known that it is transmitted by sexual and close contact, there are many unknown ways of transmission of HPV. Even in babies, hoarseness can be caused by HPV and the virus can pass from the mother to the baby through the placenta, which can lead to many problems, especially hoarseness (such as recurrent laryngeal papillomatosis).

How do papillomas occur?

Papillomas are hyperplastic squamous epithelial veins that form a very rich connective tissue that forms thin, long protrusions. Human papilloma virus (HPV) is thought to play a role in its formation. HPV is a DNA virus that causes benign proliferation of epithelial tissue when it causes disease in the larynx mucosa. There are many types of HPV. Among these, HPV-6 and HPV-11 are most commonly involved in papilloma formation. These two subtypes are responsible for a very large proportion of warts in the genital area.

HPV infection was detected in mothers of 20-60% of children with laryngeal papilloma

Genital wart (condyloma acuminatum) present in the mother has been shown to be associated with laryngeal papilloma - vocal cord papilloma in children. Condyloma acuminatum was detected in mothers of 20-60% of children with laryngeal papilloma. The transmission is thought to be through the mother's birth canal. As a matter of fact, papilloma is rarely seen in children born by cesarean section.

Clinical overview of oral HPV infection

Papillomas typically present as multiple wart-like lesions. Although they can be seen anywhere in the upper airway, they usually affect actual vocal cords and false vocal cords (ventricular bands). 2-15% of patients in the trachea (located below the vocal cords) and the esophagus can also be seen in the disease. The first complaint that brings patients to the physician is generally hoarseness. Wheezing during breathing, coughing, difficulty breathing, and eating or swallowing pain can also cause complaints.

Treatment of larynx papilloma

Since the virus that forms the papilloma can also be found in the tissues that appear normal, the disease cannot be cured completely. The first goal of the treatment is to keep the airway open and the second is to provide sufficient quality sound. For this purpose, it should be aimed to perform surgery in a way that causes the least scar tissue and least damages the healthy tissues.

Recurrences are common. There is a small risk of developing malignant pathologies.

Larynx papilloma treatment is very difficult because of its frequent recurrence

Vocal cord papilloma is a benign lesion of the larynx and vocal cords. Larynx papilloma treatment is very difficult because of its frequent recurrence. Many times, endoscopic airway examination and surgical treatment may be necessary as needed.

In the presence of recurrent respiratory papillomatosis (RRP), tracheotomy should be avoided as much as possible to prevent stomal involvement. Papilloma virus is found in the superficial epithelial layer. The viral capsid antigen is found in the outer layers of the diseased epithelium, so it is important to remove all exophytic lesions. Although the appearance of HPV-related lesions may rarely be confused with carcinoma (vocal cord cancer), pathological specimens should be taken. The nasopharyngeal side of the nasopharynx and soft palate where the RRP may be occult and the lower face of the vocal cords should be examined. Jet ventilation should not be preferred as it can be sown in the lower respiratory tract.

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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